Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study Clinical Trial Controlled Clinical Trial
Perioperative thromboelastography and sonoclot analysis in morbidly obese patients.
To investigate perioperative coagulation in morbidly obese (MO) patients with the thromboelastograph (TEG) and Sonoclot analyzer. ⋯ The MO group demonstrated accelerated fibrin formation, fibrinogen-platelet interaction, and platelet function compared with lean controls but no difference in fibrinolysis. Viscoelastic measures of coagulation may be useful in MO patients, who are at increased risk of thromboembolic events.
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The effect of isoflurane on the subcortical P14 component of the median nerve somatosensory evoked potential (SEP) is poorly known. We studied whether the P14 wave from the upper brainstem, recorded with a nasopharyngeal electrode, was attenuated at the isoflurane-induced EEG burst-suppression level. We also compared the effect of isoflurane on the P14, cervical N13 and cortical N20, N35 and N6, components. ⋯ We conclude that P14 can reliably be recorded with nasopharyngeal electrodes during isoflurane anaesthesia, even during EEG burst-suppression, when the N20 wave is attenuated. In contrast, the middle-latency SEP components are sensitive to isoflurane anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Opioid sedation does not alter intracranial pressure in head injured patients.
This study aimed to examine the effects of sedative doses of morphine, fentanyl and sufentanil on intracranial pressure (ICP) in head-injured patients in whom changes in mean arterial pressure (MAP) were minimized. ⋯ The study suggests that when opioids are titrated in head-injured patients, worsening intracranial pressure can be avoided.
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Comparative Study
Risk of unanticipated intraoperative events in patients assessed at a preanaesthetic clinic.
To determine the risk of unanticipated intraoperative events (UIE) in patients assessed at a preanaesthetic clinic compared with those not assessed at the clinic. ⋯ Although clinic patients were more often optimally prepared, their adjusted risk of UIE was higher than nonclinic patients. The procedural anaesthetist needs to be vigilant with these high risk patients, even if they have been assessed at a preanaesthetic clinic.
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Comparative Study
Testing the raters: inter-rater reliability of standardized anaesthesia simulator performance.
Assessment of physician performance has been a subjective process. An anaesthesia simulator could be used for a more structured and standardized evaluation but its reliability for this purpose is not known. We sought to determine if observers witnessing the same event in an anaesthesia simulator would agree on their rating of anaesthetist performance. ⋯ The use of videotapes allowed the scenarios to be scored by reproducing the same event for each observer. There was excellent inter-rater agreement within the confines of the study. Rating of video recordings of anaesthetist performance in a simulation setting can be used for scoring of performance. The validity of the scenarios and the scoring system for assessing clinician performance have yet to be determined.