European journal of anaesthesiology
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Randomized Controlled Trial
Physostigmine and anaesthesia emergence delirium in preschool children: a randomized blinded trial.
A significant proportion of preschool children experiences severe emergence agitation after anaesthesia. The symptoms of disorientation, restlessness, inconsolable crying and thrashing resemble an acute psychosis similar to an agitated central anticholinergic syndrome. The primary aim of this randomized controlled study was to assess the efficiency of the cholinesterase-inhibitor physostigmine in these children and to identify adverse effects. ⋯ Severe emergence agitation might be related to a central anticholinergic syndrome as diagnosed empirically with a successful treatment with physostigmine. However, the results of this study do not support its routine use. The substance may augment the therapeutic options if injected slowly and after suitable prophylaxis to avoid postoperative nausea and vomiting.
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The Bullard laryngoscope can be useful in management of difficult airway. When the endotracheal tube is advanced over the original Bullard laryngoscope stylet, the endotracheal tube sometimes makes contact with structures around the vocal cords, especially the right arytenoids. A similar problem also occurs with flexible fibreoptic intubation and it has been shown that use of the Parker Flex-Tip tube usually resolves the problem. In this study we tested our hypothesis that use of the Parker Flex-Tip tube might improve endotracheal tube passage with the Bullard laryngoscope. ⋯ During intubation with the Bullard laryngoscope, use of the Parker Flex-Tip tube is associated with more rapid success and a lower incidence of re-direction of the Bullard laryngoscope during endotracheal intubation when compared to a standard endotracheal tube.
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Randomized Controlled Trial Comparative Study
Comparison of double-lung jet ventilation and one-lung ventilation for thoracotomy.
Thoracic surgery requires immobilization of the operating area. Usually, this is achieved with one-lung ventilation (OLV), however this may still lead to some movement. High-frequency jet ventilation (HFJV) may be an alternative way of ventilation in thoracic surgery. The purpose of this study was to determine the effectiveness of HFJV as an alternative option to OLV for thoracic procedures. ⋯ HFJV is safe option, comparable to OLV and offers some advantages for open-chest thoracic procedures.
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Comparative Study
In vivo ultrasound real-time motion of the cervical spine during intubation under manual in-line stabilization: a comparison of intubation methods.
In emergency trauma situations, manual in-line stabilization of the cervical spine is recommended to reduce cervical spine movement during intubation. The aim of this study was to compare the effect of manual in-line stabilization during different intubation techniques on three-dimensional cervical spine movements and times to intubation. ⋯ The intubating laryngeal mask airway with manual in-line stabilization is a potentially useful adjunct to intubation of patients with potential cervical spine injury, if there are no contraindications to these methods. These results predict that fibreoptic procedures may be a safe instrument for airway management in patients with potential cervical spine injuries; however, the main disadvantages are the longer intubation times.
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To evaluate the current clinical attitude in enteral nutrition support and motility disorders in adult critically ill patients on German intensive care units. ⋯ The concept of early enteral nutrition has been well established and approved in German intensive care units, though the recommendations only meet level C criteria in the current ESPEN guidelines. The current survey may serve for further updates on practical nutrition support in intensive care medicine.