Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2003
Randomized Controlled Trial Clinical TrialThe effect of an alveolar recruitment strategy on oxygenation during laparascopic cholecystectomy.
This prospective randomized controlled trial examined the effect of an "alveolar recruitment strategy" (ARS) in healthy patients having laparoscopic cholecystectomy. Twenty-four consecutive ASA 1 or 2 patients were randomly allocated to an ARS or control group. All patients were manually ventilated to a maximal airway pressure of 25 to 30 cmH2O or a tidal volume of 10 ml/kg during induction of general anaesthesia. ⋯ No adverse effects were reported. ARS improved arterial oxygenation intraoperatively in healthy patients having laparoscopic cholecystectomy, without clinical cardiovascular compromise or respiratory complication. We conclude that this alveolar recruitment strategy is a useful method of increasing arterial oxygenation.
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Larsen syndrome is a rare congenital connective tissue disorder which is characterized by multiple dislocations of major joints, typical facial appearance, cervical spine narrowing and instability and respiratory difficulties secondary to laryngotracheomalacia. A case of general anaesthesia for laparoscopic hernia repair in a male child aged 16 months with this syndrome is presented. Anaesthesia was well tolerated though intubation proved difficult. Cervical spine instability and postoperative respiratory complications are potential problems.
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Anaesth Intensive Care · Apr 2003
Randomized Controlled Trial Clinical TrialAlfentanil infusion as a component of intravenous anaesthesia for coronary artery bypass surgery with "fast-track" recovery.
Alfentanil and propofol total intravenous anaesthesia was assessed in 25 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass (CPB). A manually controlled alfentanil infusion, calculated from estimated lean body mass and published pharmacokinetic data, was effective in achieving target plasma concentrations, while the "Diprifusor" system was used to vary propofol target concentrations according to changes in haemodynamics and anaesthetic requirement. The effects of CPB on alfentanil plasma concentrations were offset by changes in protein binding and free-fraction of the drug. With the use of only two target plasma concentrations for alfentanil (changed after CPB), a pre-determined infusion profile ensured effective plasma concentrations during surgery and concentrations unlikely to inhibit extubation within six hours of sternal closure.
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Anaesth Intensive Care · Apr 2003
Randomized Controlled Trial Comparative Study Clinical TrialThe use of modified VBM laryngeal tube compared to Laryngeal Mask Airway during spontaneous ventilation.
We have compared the use of the laryngeal mask airway with the new modified laryngeal tube in a prospective randomized controlled study. Sixty ASA 1 or 2 patients, aged 18 to 65 years, scheduled for elective surgery and breathing spontaneously under general anaesthesia, were studied. After preoxygenation, anaesthesia was induced with fentanyl and propofol. ⋯ Postoperative complications were recorded. We found that the incidence of partial airway obstruction needing intraoperative airway manipulation was higher with the laryngeal tube than with the laryngeal mask airway. We conclude that during spontaneous ventilation the modified laryngeal tube is not as reliable in providing a satisfactory airway and we consider it is not a suitable alternative to the laryngeal mask airway.
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Anaesth Intensive Care · Apr 2003
Clinical TrialHigh-density EEG mapping during general anaesthesia with xenon and propofol: a pilot study.
Anaesthetic-induced spatial inhomogeneities of the electrencephalogram(EEG) using "high density" electrode mapping have not previously been reported. We measured the scalp EEG with a dense electrode (128-channel) montage during the course of light general anaesthesia with xenon and then propofol in normal human subjects. EEG was measured during induction and recovery of general anaesthesia in five normal subjects, and we obtained analysable data from three of these subjects. ⋯ Anaesthesia-induced delta and theta waves were differentially distributed along the anterior-posterior axis of the brain in a manner that corresponds well to the anatomy of putative neuronal generators. The distribution of anaesthetic-induced changes in fast gamma-band power seems to reflect functional differences between the posterior and anterior aspects of the cerebral cortex. These preliminary observations were consistent within our small sample, indicating that larger studies of anaesthetic effects using high-density recordings are warranted.