Anaesthesia
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Infusion devices for continuous and precise drug administration are indispensable tools in anaesthesia and critical care medicine. Problems such as start-up delays, non-continuous flow and susceptibility to hydrostatic pressure changes at low infusion rates resulting in accidental bolus release or prolonged flow interruption are inherent to current infusion technology. ⋯ The performance of the MVIP prototype has been evaluated and compared with standard syringe infusion pump assemblies. The novel MVIP concept has thereby proven to eliminate most problems during infusion start-up, steady state flow and vertical pump displacement, and has the potential of revolutionising infusion technology and setting a new dimension in patient safety.
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Randomized Controlled Trial Clinical Trial
Effect of xenon anaesthesia on accuracy of cardiac output measurement using partial CO2 rebreathing.
Cardiac output (CO) determination based on partial CO(2) rebreathing has recently been introduced into clinical practice. The determination of flow is crucial for exact CO readings and the physical properties of xenon, i.e. high density and viscosity, may influence flow readings. This study compared echocardiography-derived CO measurements with the partial rebreathing method during total intravenous (TIVA) vs. xenon-based anaesthesia. ⋯ Xe -4.0 +/- 2.1 l.min(-1)). In the TIVA group, bias and precision after declamping increased significantly (P < 0.01) compared to all time points except baseline. In its current application, the NICO cardiac output monitor appears to be inappropriate for determination of CO during xenon based anaesthesia.
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Changes in the tracheal tube tip to carina distance were measured by radiographic screening following various head postures in 45 children undergoing cardiac catheterisation under general anaesthesia who were intubated via nasal and oral routes. Extension of the head moved the tracheal tube away from the carina and flexion moved it towards the carina in both routes. ⋯ In contrast, flexion produced greater downward movement in the nasal route in some patients. The direction of movement with lateral rotation and use of a shoulder roll was inconsistent.
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Although site of surgery and previous occurrence of postoperative nausea and vomiting are often used to decide whether prophylactic anti-emetic drugs are indicated, the value of these predictors is unclear. We compared these two risk factors against a simplified four-factor risk score. We analysed data from 1566 adult inpatients who received balanced anaesthesia without prophylactic anti-emetics. ⋯ Sensitivity and specificity were, respectively, 47% and 59% for surgical site; 47% and 70% for history of postoperative nausea and vomiting; and 58% and 70% for risk score with three or more factors. The area under the curve for surgical site was 0.53 (95% CI 0.50-0.56); that for patient's history was 0.58 (95% CI 0.56-0.61) while for risk score it was 0.68 (95% CI 0.66-0.71; P < 0.001). Prediction using surgical site or patient's history alone was poor while the simplified risk score provided clinically useful sensitivity and specificity.