Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2016
ReviewSpeckle tracking echocardiography in the critically ill: enticing research with minimal clinical practicality or the answer to non-invasive cardiac assessment?
Echocardiography is developing rapidly. Speckle tracking echocardiography is the latest semi-automatic tool that has potential to quantitatively describe cardiac dysfunction that may be unrecognised by conventional echocardiography. It is a non-Doppler, angle-independent, feasible and reproducible method to evaluate myocardial function in both non-critically ill and critically ill populations. ⋯ We should be cautious in accepting that the latest software used in cardiology cohorts will automatically be the answer in the critically ill. Even with these limitations the technology is enticing and results fascinating. We are uncovering previously undescribed dysfunction and although it currently is essentially a research-based activity, there is great promise as a clinical tool as echocardiography analysis becomes more automated, and potentially speckle tracking echocardiography could help describe cardiac function in critical illness more accurately than is possible with current techniques.
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Anaesth Intensive Care · Sep 2016
Randomized Controlled TrialOptimal flexible laryngeal mask airway size in children weighing 10 to 20 kg.
This prospective, randomised study was conducted to assess the effect of flexible laryngeal mask airway (FLMA) size on oropharyngeal leak pressure (OLP) in children at the recommended intracuff pressure. A total of 120 children undergoing elective ophthalmic surgery were randomly assigned to the size 2 FLMA group or size 2.5 FLMA group. The primary measurement was OLP at an intracuff pressure of 40 cmH2O. ⋯ In subgroup analyses based on weight, the size 2.5 FLMA had a lower occurrence of OLP <10 cmH2O and insufficient ventilation (27% versus 0, P=0.0046) in children 16-20 kg. We conclude that at a 40 cmH2O intracuff pressure, the OLP with the size 2 and size 2.5 FLMA was similar in children weighing 10-15.9 kg. However, in children weighing 16-20 kg, size 2 devices had a higher incidence of low OLP and insufficient ventilation, so a 2.5 FLMA may be preferable in this subgroup.
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Anaesth Intensive Care · Sep 2016
Editorial CommentAnaesthetic implications of mild cognitive impairment.
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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.