Anaesthesia
-
Randomized Controlled Trial Comparative Study
A randomised controlled trial comparing rocuronium priming, magnesium pre-treatment and a combination of the two methods.
We investigated whether magnesium sulphate combined with rocuronium priming shortens the onset of neuromuscular blockade, compared with these methods used alone. Ninety-two patients scheduled for general anaesthesia were randomly allocated to one of four groups: controls were given 0.6 mg.kg(-1) rocuronium; patients in the prime group were given 0.06 mg.kg(-1) rocuronium three minutes before a further dose of 0.54 mg.kg(-1) rocuronium; patients in the magnesium group were given an infusion of 50 mg.kg(-1) magnesium sulphate before rocuronium and patients in the magnesium and prime group were given both the magnesium sulphate and the priming dose of rocuronium. Tracheal intubation was attempted 40 s after the rocuronium injection. ⋯ No statistical difference was found for the duration of blockade. As for adverse events, a burning or heat sensation was reported in eight (35%) and six (26%) patients in the magnesium and magnesium and prime groups, respectively. The combination of magnesium sulphate and rocuronium priming accelerated the onset or neuromuscular blockade and improved rapid-sequence intubating conditions, compared with either magnesium sulphate or priming used alone.
-
Randomized Controlled Trial
The educational value of using cumulative sum charts.
Various workplace-based assessment tools are available, but none have been shown to improve performance in procedural skills. This study aimed to assess the impact of using one such tool, cumulative sum charts, on procedural skill ability. A single-blind randomised controlled trial was conducted on 82 final year medical students. ⋯ Students in the intervention group obtained median (IQR [range]) scores of 68.2 (60.5-74.3 [42.7-81.1]) vs 62.2 (52.2-68.8 [40.7-80.5]) for the control group (p = 0.013). The effect size was moderate (Cohen's d = 0.608). This study therefore provides support for the hypothesis that use of cumulative sum charts improves performance when learning procedural skills.
-
Randomized Controlled Trial Comparative Study
Comparison of the antitussive effect of remifentanil during recovery from propofol and sevoflurane anaesthesia.
This prospective randomised study compared the antitussive effect of remifentanil during recovery from either propofol or sevoflurane anaesthesia. Seventy-four female patients undergoing thyroidectomy were anaesthetised with either propofol and remifentanil or sevoflurane and remifentanil. ⋯ Time to awakening and time to extubation were significantly shorter in the propofol group (4.7 min, 6.1 min min, respectively) compared with the sevoflurane group (7.9 min and 8.9 min respectively) (p < 0.001 and p = 0.002, respectively). An effect-site concentration of 2 ng.ml(-1) of remifentanil was associated with smooth emergence from both propofol and sevoflurane anaesthesia.
-
Ultrasound guidance is now common in regional anaesthesia practice, but remains limited by poor visibility of the needle tip and poor quantification of local anaesthetic spread. Sonoelastography based on tissue compression is a technique depicting tissue strain. Hitherto used largely for tumour diagnosis, we used it in both Thiel embalmed cadavers and two patients receiving interscalene and femoral blocks to observe changes in tissue strain during local anaesthetic injection. ⋯ Post-hoc analysis showed greater spread with 1 and 2.5 ml volumes compared with 0.25 ml. In patients, visibility of strain during injection was better with sonoelastography than with B-Mode ultrasound and showed a dose response from 1 to 5 ml volumes of local anaesthetic. Colour strain recognition using sonoelastography offers the ability to differentiate between nerve and surrounding tissue during local anaesthetic injection by improving visibility of spread (p = 0.04).