Anaesthesia and intensive care
-
Anaesth Intensive Care · Apr 2007
Randomized Controlled Trial Comparative StudyPerformance comparison of two anaesthetic facemasks.
When considering anaesthetic masks, the quality of the mask-face seal is a key determinant of performance. This randomised crossover trial utilises expired oxygen concentration to compare the efficacy of two routinely used facemasks. Thirty subjects were randomised to breathe 100% oxygen via either a traditional reusable black rubber mask or the disposable Intersurgical Scented mask for three minutes. ⋯ From the oxygen wash-in curves, the Intersurgical mask consistently outperformed the black rubber mask. At three minutes the Intersurgical mask performed better than the black rubber mask, with mean end-tidal oxygen concentrations of 86.9% vs. 81% respectively; P=0.008. These findings indicate that the soft cuff design of the intersurgical mask provided a better seal than the black rubber facemask.
-
Anaesth Intensive Care · Apr 2007
ReviewUpdate in computer-driven weaning from mechanical ventilation.
Weaning from mechanical ventilation is a complex process requiring assessment and interpretation of both objective and subjective clinical parameters. For many years, automated computerised systems for various medical processes, including respiratory management, have been proposed to optimise decision-making and reduce variation amongst clinicians. SmartCare/PS, available since 2003 as a software application for the EvitaXL ventilator (Dräger Medical AG & Co. ⋯ Of potential clinical note, a recent study suggested that use of SmartCare/PS might be associated with useful reductions in the duration of weaning compared to existing clinical practice using weaning protocols. One recently published randomised trial supports this conclusion. However, given the known large variation in international critical care ventilatory practices further randomised trials are desirable.
-
Anaesth Intensive Care · Apr 2007
Randomized Controlled TrialThe use of ketamine as rescue analgesia in the recovery room following morphine administration--a double-blind randomised controlled trial in postoperative patients.
In some patients, control of postoperative pain can be difficult with morphine alone. This double-blind randomised controlled trial was designed to evaluate whether a small bolus dose of ketamine could improve pain scores in those patients who had inadequate relief of their postoperative pain after two standard doses of morphine. Forty-one patients with uncontrolled postoperative pain were randomly assigned to receive either morphine (M) alone, or morphine plus 0.25 mg/kg ketamine (K) in the recovery room. ⋯ There was no statistically significant difference in verbal rating scale pain scores between the two groups either in the recovery room (K = 5.16, M = 6.28, P = 0.065), or at a later time on the ward. There was no apparent difference between groups in sedation, morphine consumption, postoperative nausea and vomiting, quality of recovery or need for rescue analgesia. We could not demonstrate an effective role for ketamine in the management of problematic postoperative pain at the dose studied.
-
Anaesth Intensive Care · Apr 2007
Comparative StudyA comparison of the degree of residual mitral regurgitation by intraoperative transoesophageal and follow-up transthoracic echocardiography following mitral valvuloplasty.
Patients who undergo mitral valve repair for mitral regurgitation and have mild residual mitral regurgitation may have an increased risk of re-operation in future years. Intraoperative transoesophageal echocardiography has now become a standard of practice for mitral valve repair surgery. We identified 106 patients who underwent attempted mitral valve repair over a three-year period in our institution. ⋯ Mild residual mitral regurgitation on intraoperative transoesophageal echocardiography was not reliably associated with mild mitral regurgitation on follow-up transthoracic echocardiography. In fact, 61% of patients with mild mitral regurgitation identified by intraoperative transoesophageal echocardiography had reduced mitral regurgitation at follow-up transthoracic echocardiography (to nil/trace residual mitral regurgitation). This observation, in conjunction with the limitations of the data supporting the goal of 'echo perfect' repair; suggests that a second attempt at repair should not be made based on the intraoperative transoesophageal echocardiography finding of mild residual mitral regurgitation alone.