Anaesthesia
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Pulse oximetry is widely accepted as essential monitoring for safe anaesthesia, yet is frequently unavailable in resource-limited settings. The Lifebox pulse oximeter, and associated management training programme, was delivered to 79 non-physician anaesthetists attending the 2011 Uganda Society of Anaesthesia Annual Conference. ⋯ Immediately following the course, the test score increased to 41 (38-43 [25-47]); p < 0.0001 and at the follow-up visit at 3-5 months it was 41 (39-44 [33-49]); p = 0.001 compared with immediate post-training test scores, and 75/79 (95%) oximeters were in routine clinical use. This method of introduction resulted in a high rate of uptake of oximeters into clinical practice and a demonstrable retention of knowledge in a resource-limited setting.
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The aim of this study was to investigate cardiac function and haemodynamic indices using transthoracic echocardiography in women with severe pre-eclampsia who had already received treatment interventions. Fifteen women with treated severe pre-eclampsia were studied using transthoracic echocardiography. Mean (SD) cardiac output in women with treated disease was 5690 (1708) ml.min(-1). ⋯ Left ventricular mass was increased at 182.0 (44.4) g. There was large variability in haemodynamics in women with treated severe pre-eclampsia. Transthoracic echocardiography is acceptable and applicable and enables quantification of cardiac function in women with severe pre-eclampsia.
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Doxapram is the only dedicated respiratory stimulant used to aid recovery of breathing after major surgery. Doxapram acts on peripheral chemoreceptors and although the central action of doxapram has been suggested, its detailed neuronal mechanism is unknown. We assessed doxapram-induced changes in spontaneous cervical nerve (C4) inspiratory activity and the firing of action potentials in pre-inspiratory and inspiratory neurones in the medulla. ⋯ Doxapram application (for 15 min) increased the frequency and amplitude of C4 activity dose-dependently. Doxapram induced changes in the electrophysiological properties of pre-inspiratory and inspiratory neurones. Our results suggest that respiratory activity enhancement was likely to be induced via effects on the potassium channels of pre-inspiratory and inspiratory neurones and indicate the central actions of doxapram.
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Debate continues over the most appropriate blood-brain equilibration rate constant (ke0) for use with the Marsh pharmacokinetic model for propofol. We aimed to define the optimal ke0 value. ⋯ A median 'apparent ke0' value of 0.61 min(-1) (95% CI 0.37-0.78 min(-1)) led to the greatest probability of achieving a stable clinical effect when the effect-site target was fixed at the effect-site concentration displayed by the target-controlled infusion system, at the time when a desired depth of sedation had been reached. By utilising a clinically relevant endpoint to derive this value, inter-individual pharmacokinetic and pharmacodynamic variability may be accounted for.
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We analysed the results of the first phase of the Zurich Unexpected Difficult Airway course. Two hundred and twenty-eight staff members performed a total of 2712 standardised airway rescue procedures with four airway devices: SensaScope™, LMA Fastrach™, Laryngeal Tube and needle cricothyrodotomy. Four consecutive attempts were performed using each device. ⋯ The success rates and mean (SD) completion times for all participants were 96.2% and 30.2 (15.3) s for the SensaScope, 88.1% and 40.4 (17.2) s for the LMA Fastrach, 99.0% and 12.1 (10.6) s for the Laryngeal Tube and 99.0% and 12.3 (6.1) s for needle cricothyroidotomy. The learning curves resulting from the four consecutive attempts with each device showed a clear pattern of improvement. This institutional airway training course represents a promising method to improve the capability of practitioners to cope with unexpected difficult airway situations.