Anaesthesia
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Review
A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility.
Echocardiography is migrating rapidly across speciality boundaries and clinical demand is expanding. Echocardiography shows promise for evolving applications in the peri-operative assessment and therapeutic management of patients undergoing non-cardiac surgery, whether it be elective or emergency. ⋯ The discussion around more widespread incorporation of cardiac ultrasound into anaesthetic practice must take into account competency, training and governance. Failure to do so adequately may mean that the use of echocardiography is poorly applied and costly.
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Randomized Controlled Trial Comparative Study
A prospective randomised comparison of two insertion methods for i-gel(™) placement in anaesthetised paralysed patients: standard vs rotational technique.
In this prospective randomised study, we compared two techniques for i-gel(™) insertion. One hundred and eighty-one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i-gel was inserted using the standard technique. ⋯ The mean (SD) insertion time was longer (26.9 (14.5) s vs. 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cm H2O vs. 27.1 (9.4) cm H2O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs. 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i-gel insertion.
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We hypothesised that an in-vivo adjustment method and/or a newer sensor would increase the accuracy of non-invasive and continuous haemoglobin monitoring (SpHb) measurements. Two sensors, the R1-25 and R2-25a (the newer version), were used with laboratory total haemoglobin concentration (tHb) values simultaneously recorded. In-vivo adjusted SpHb (AdHb) was calculated by a simple formula: AdHb = SpHb - (1(st) SpHb - 1(st) tHb). ⋯ In-vivo adjustment improved the correlation coefficient between SpHb and tHb from 0.86 to 0.95 for the R1-25 and from 0.83 to 0.93 for the R2-25a. There was no difference between the R1-25 and R2-25a sensors. The in vivo adjustment method improved the accuracy of SpHb measurements in both sensors.