Anaesthesia
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Randomized Controlled Trial Comparative Study
Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction.
This study investigates the effect of suxamethonium vs rocuronium on the onset of haemoglobin desaturation during apnoea, following rapid sequence induction of anaesthesia. Sixty patients were randomly allocated to one of three groups. Anaesthesia was induced with lidocaine 1.5 mg.kg(-1), fentanyl 2 microg.kg(-1) and propofol 2 mg.kg(-1), followed by either rocuronium 1 mg.kg(-1) (Group R) or suxamethonium 1.5 mg.kg(-1) (Group S). ⋯ The median (IQR [range]) time to reach S(p)O(2) of 95% was significantly shorter in Group S (358 (311-373 [245-430]) s) [corrected] than in Group R (378 (370-393 [366-420]) s; p = 0.003), and shorter in Group SO (242 (225-258 [189-270]) s) [corrected] than in both Group R (p < 0.001) and Group S (p < 0.001). When suxamethonium is administered for rapid sequence induction of anaesthesia, a faster onset of oxygen desaturation is observed during the subsequent apnoea compared with rocuronium. However, time to desaturation is prolonged whenever lidocaine and fentanyl precede suxamethonium.
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The LMA Supreme has been suggested for use in emergency situations by medical personnel with no experience in endotracheal intubation. We evaluated the LMA Supreme when inserted by non-anaesthetists, firstly in a manikin and then in patients. Fifty airway novices inserted a LMA Supreme in a manikin without any complications so we proceeded to the patient phase. ⋯ Results are consistent with previous studies of use of the LMA Supreme by airway experts. We conclude that the LMA supreme is suitable for use by airway novices. Further research is needed before it may be recommended for cardiopulmonary resuscitation and emergency airway use.
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Our aim was to assess if peri-operative blood transfusion is an independent risk factor for mortality and morbidity in the elderly. We report the results of a cohort study of all patients aged 80 or more on the day of their emergency or elective cardiac surgery (n = 874), using routinely collected data from January 2003 to November 2007. The primary outcome was all-cause mortality in hospital. ⋯ Relative to 0-2 units, the odds ratio for > 2 units was 6.80 (95% CI 2.46-18.8), and for other additional blood products was 14.4 (95% CI 5.34-37.3), with a p value of < 0.001. Duration of stay in the ICU was significantly associated with the amount of blood products administered (median (IQR [range]) ICU stay 1 (1-2 [0-15]) day if transfused 0-2 units of red blood cells, 2 (1-6 [0-128]) days if transfused > 2 units of red blood cells and 3 (1-76 [0-114]) days if other clotting products were used; p value < 0.001). Hospital stay was also associated with the amount of red cells used (p < 0.001).
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The goals for ambulatory surgery are rapid recovery with minimal side effects, adequate postoperative pain control, rapid patient discharge and overall cost containment. The addition of regional anaesthetic techniques has been shown to decrease nausea, postoperative pain scores and the need for post-anaesthesia care unit monitoring. The use of regional anaesthesia is increasing as studies confirm the goals for ambulatory anaesthesia can be met with a combination of regional anaesthesia and a multimodal pain management regimen.
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Regional anaesthesia can marvellously dull the pain (and limit some other complications) of trauma, surgery and childbirth. But like all powerful techniques, it may have complications. Here the complications of regional anaesthesia are reviewed. The risks, presentation and the management of these complications are discussed in turn.