Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2009
Randomized Controlled Trial Comparative StudyA randomised, single-blind, controlled trial of silicone disposable laryngeal masks during anaesthesia in spontaneously breathing adult patients.
We hypothesised that two new silicone disposable laryngeal mask airways, Meditech Systems Limited (MSL) and ProAct (PA), would perform similarly to the Classic Laryngeal Mask Airway (cLMA) in spontaneously breathing adult patients. One hundred and twenty consecutive adult patients were prospectively enrolled and randomly allocated to one of three groups (PA, MSL, cLMA). All patients received a standardised anaesthetic and insertion technique. ⋯ There was no statistical difference in airway sealing pressures between the PA laryngeal mask airway (17.9+/-5.9 cmH2O), MSL laryngeal mask airway (18.5+/-6.9 cmH2O,) and cLMA (17.6+/-5.6 cmH2O) (P=0.816). There was no statistical difference in insertion times, ease of insertion, cuff pressure and cuff volumes. The MSL and PA disposable laryngeal mask airways provided comparable airway sealing pressures to the reusable cLMA.
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Anaesth Intensive Care · Nov 2009
ReviewThe rise of simulation in technical skills teaching and the implications for training novices in anaesthesia.
Changes in work practices have led to a decline in the opportunities for anaesthetic trainees to learn technical procedures in supervised practice. Efforts to mitigate medical error and other changes have coincided with the development of alternative training methods so that it is increasingly difficult to justify the traditional model of teaching technical procedures. The range of simulators available for training in technical procedures in anaesthesia continues to expand. ⋯ Using the available simulation equipment and educational tools, trainees can be prepared to begin supervised practice having demonstrated adequate procedural knowledge and expertise in simulation. With the use of simulated patients there is also the opportunity to integrate non-technical skills as well where appropriate. This review summarises the justification for the use of simulation in technical skills training in anaesthesia and the educational theory that supports its use, and outlines one of the available frameworks that can be used to aid its application.
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Anaesth Intensive Care · Nov 2009
Incidence of contrast-induced nephropathy in intensive care patients undergoing computerised tomography and prevalence of risk factors.
Computerised tomography (CT) with contrast is frequently used in intensive care. Contrast-induced nephropathy (CIN) is an important complication largely studied in stable cardiology patients and can lead to acute renal failure. The aim of this study was to determine the incidence of CIN in an intensive care unit (ICU) setting and describe the prevalence of associated risk factors. ⋯ ICU and hospital length of stay was not significantly different in CIN positive and negative patients and persisting renal impairment was not found in CIN positive survivors. Based on this study, we cannot predict who will develop CIN in ICU using the described risk factors. Further prospective studies are needed to evaluate the incidence and outcomes of CIN in an ICU setting.
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Anaesth Intensive Care · Nov 2009
ReviewThe efficacy of landiolol for suppressing the hyperdynamic response following laryngoscopy and tracheal intubation: a systematic review.
Landiolol is a recently developed, selective short-acting beta1-antagonist. The aim of the study was to evaluate the efficacy of landiolol for suppressing haemodynamic changes induced by laryngoscopy and tracheal intubation (LTI) in Japanese patients. A comprehensive search was undertaken to identify all randomised comparisons of landiolol with placebo that examined effects on haemodynamic responses following LTI. ⋯ The other two studies used bolus administration of landiolol (0.1 to 0.3 mg/kg), but it was difficult to evaluate the efficacy because of the limited amount of data. Landiolol administration at 0.125 mg/kg/minute for one minute followed by 0.04 mg/kg/minute effectively suppresses the increases in heart rate and blood pressure following LTI. For a bolus regimen of landiolol, further studies are required to determine the efficacy and the optimal dose and timing for suppression of haemodynamic responses following LTI.
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Anaesth Intensive Care · Nov 2009
Randomized Controlled Trial Comparative StudyComparison of equipotent doses of ropivacaine-fentanyl and bupivacaine-fentanyl in spinal anaesthesia for lower abdominal surgery.
The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 microg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 microg (group R, n =26) or plain bupivacaine 13 mg with fentanyl 20 microg (group B, n =26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. ⋯ The duration of motor block (Bromage score >0) was shorter in group R (139+/-39 minutes vs group B 182+/-46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90+/-25 minutes vs 130+/-40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 microg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 microg for spinal anaesthesia in lower abdominal surgery.