Anaesthesia
-
Review Meta Analysis
The effect of ondansetron on the efficacy of postoperative tramadol: a systematic review and meta-analysis of a drug interaction.
It is likely that there is an interaction between tramadol and ondansetron that decreases the early-postoperative analgesic efficacy of tramadol.
pearl -
Comparative Study Clinical Trial
Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage.
We compared blood component requirements during major obstetric haemorrhage, following the introduction of fibrinogen concentrate. A prospective study of transfusion requirements and patient outcomes was performed for 12 months to evaluate the major obstetric haemorrhage pathway using shock packs (Shock Pack phase). The study was repeated after the pathway was amended to include fibrinogen concentrate (Fibrinogen phase). ⋯ The median (IQR [range]) quantity of fibrinogen administered was significantly greater in the Shock Pack phase, 3.2 (0-7.1 [0-20.4]) g, than in the Fibrinogen phase, 0 (0-3.0 [0-12.4]) g, p = 0.0005. Four (9.5%) of 42 patients in the Shock Pack phase developed transfusion associated circulatory overload compared with none of 51 patients in the Fibrinogen phase (p = 0.038). Fibrinogen concentrate allows prompt correction of coagulation deficits associated with major obstetric haemorrhage, reducing the requirement for blood component therapy and the attendant risks of complications.
-
The risk of accidental over-dosing of obese children poses challenges to anaesthetists during dose calculations for drugs with serious side-effects, such as analgesics. For many drugs, dosing scalars such as ideal body weight and lean body mass are recommended instead of total body weight during weight-based dose calculations. However, the complex current methods of obtaining these dosing scalars are impractical in the peri-operative setting. ⋯ A nomogram was created and its performance compared with the standard calculation method by volunteers using measurements from 108 obese children. The nomogram was as accurate (bias 0.12 kg vs -0.41 kg, respectively, p = 0.4), faster (mean (SD) time taken 2.8 (1.0) min (vs 3.3 (0.9) min respectively, p = 0.003) and less likely to result in mistakes (significant errors 3% vs 19%, respectively, p = 0.001). We present a system that simplifies estimation of ideal body weight and lean body mass in obese children, providing foundations for safer drug dose calculation.
-
Randomized Controlled Trial Comparative Study
Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation.
In-line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C-MAC(®) (n = 26) or GlideScope(®) (n = 30), when the head and neck were stabilised in-line. There was no significant difference in the median (IQR [range]) intubation times between the C-MAC (19 (14-35 [9-90]) s and the GlideScope (23, (15-32 [8-65]) s. ⋯ The laryngeal view was excellent and comparable with both devices, with the C-MAC requiring significantly more attempts and optimising manoeuvers (11 vs 5, respectively, p = 0.04). There were no significant differences in postoperative complaints e.g. sore throat, hoarseness and dysphagia. Both devices provided an excellent glottic view in patients with cervical spine immobilisation, but tracheal intubation was more often successful on the first attempt with the GlideScope.
-
Animal studies have shown that injection pressures > 75 kPa indicate probable intrafascicular needle tip position. This study describes the flow/pressure characteristics of seven common needle systems. A syringe pump delivered flow rates of 5, 6.67, 10, 13.3, 15 and 20 ml.min(-1) through these needle systems, while keeping the needle tips open to atmosphere. ⋯ Flow rates > 17 ml.min(-1) and needle sizes 22 G and smaller produced mean plateau pressures > 75 kPa. Pressure monitors upstream from the needle may produce false-positive alarms at high flow rates due to needle resistance, and unreliable readings due to non-laminar flow. We recommend injection rates ≤ 15 ml.min(-1) (0.25 ml.s(-1) ) to reduce the effect of factors upstream from the needle tip as a cause of high pressure readings.