Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2016
Review Meta AnalysisDoes objective measurement of tracheal tube cuff pressures minimise adverse effects and maintain accurate cuff pressures? A systematic review and meta-analysis.
Correct inflation pressures of the tracheal cuff are recommended to ensure adequate ventilation and prevent aspiration and adverse events. However there are conflicting views on which measurement to employ. The aim of this review was to examine whether adjustment of cuff pressure guided by objective measurement, compared with subjective measurement or observation of the pressure value alone, was able to prevent patient-related adverse effects and maintain accurate cuff pressures. ⋯ These included cough at two hours (odds ratio [OR] 0.42, confidence interval [CI] 0.23 to 0.79, P=0.007), hoarseness at 24 hours (OR 0.49, CI 0.31 to 0.76, P <0.002), sore throat (OR 0.73, CI 0.54 to 0.97, P <0.03), lesions of the trachea and incidences of silent aspiration (P=0.001), as well as maintaining accurate cuff pressures (Hedges' g 1.61, CI 2.69 to 0.53, P=0.003). Subjective measurement to guide adjustment or observation of the pressure value alone may lead to patient-related adverse effects and inaccuracies. It is recommended that an objective form of measurement be used.
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Anaesth Intensive Care · Sep 2016
Use of the Montreal Cognitive Assessment test to investigate the prevalence of mild cognitive impairment in the elderly elective surgical population.
Postoperative cognitive disorders are common in elderly patients. Pre-existing cognitive impairment including mild cognitive impairment may be an important risk factor for developing postoperative cognitive dysfunction and may not be detected in a standard preoperative interview, yet is not routinely sought. Our primary aim was to estimate the prevalence of mild cognitive impairment among elderly patients presenting to our hospital for elective surgery using a simple established screening tool: the Montreal Cognitive Assessment test. ⋯ No patients in the sample had a recorded diagnosis of mild cognitive impairment. Testing in either the preadmission clinic or on admission on the day of surgery yielded similar results. We found the Montreal Cognitive Assessment test to be a simple screening tool that was easily administered during the pre-admission visit.
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Anaesth Intensive Care · Sep 2016
Anaesthetic management of obese parturients: what is the evidence supporting practice guidelines?
Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) ≥ 40 kg/m2 and the provision of early epidural analgesia in labour. ⋯ The elements required for effective implementation in multidisciplinary maternity care are considered. We identify gaps in the current literature and suggest areas for future research. While prospective cohort studies addressing epidural extension ('top-up') in obese parturients would help inform practice, audit of local practice may better answer the question "is early epidural analgesia beneficial to obese women in my practice?".