Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2009
Case ReportsA failure of M-Entropy to correctly detect burst suppression leading to sevoflurane overdosage.
Electroencephalogram depth of anaesthesia monitors are increasingly being used, with the aim of reducing awareness during anaesthesia. Most literature concentrates on the ability of these monitors to predict when a patient is likely to be aware. This case report highlights the opposite problem, where the monitor (M-Entropy) indicated an awake state but the patient was in fact deeply anaesthetised. If the anaesthetist is unable to interpret the raw electroencephalogram and understand the limitations of the monitor being used, excessive doses of anaesthetic may be given with potentially serious consequences.
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Anaesth Intensive Care · Nov 2009
Comparative StudyCricothyroidotomy: comparison of three different techniques on a porcine airway.
We compared three different cricothyroidotomy techniques on a cadaveric porcine airway model to determine the most rapid, successful and safe method in emergency situations. In this observational comparative bench-test, surgical or scalpel cricothyroidotomy (ST), Cook Melker Cricothyrotomy Kit (CM) and Portex Cricothyroidotomy Kit (PCK) were evaluated. After a familiarisation program, four operators performed five procedures using each of the techniques. ⋯ There were no significant anatomical variations in the pig larynxes. We conclude that the CM technique is safe, rapid and has a significantly higher success rate in achieving an artificial airway in this airway model. Overall, all the participants in our study preferred to use this kit in an emergency situation.
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Anaesth Intensive Care · Nov 2009
Randomized Controlled Trial Comparative StudyContinuous intra-articular infusion of ropivacaine after unilateral total knee arthroplasty.
Intra-articular infusion of local anaesthetic after joint arthroplasty is attractive in that it is simple and will not cause motor block. However the efficacy of the technique has yet to be established. We enrolled 66 patients scheduled for unilateral total knee arthroplasty under general anaesthesia and single-shot femoral and sciatic nerve blocks. ⋯ There were two cases of infection, both in the treatment groups. No positive benefit of intra-articular infusion of local anaesthetic after total knee arthroplasty could be identified. On the contrary there may be negative effects in terms of expense, pain and possibly infection risks.
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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.