Anaesthesia
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Comparative Study
Comparative study of Poincaré plot analysis using short electroencephalogram signals during anaesthesia with spectral edge frequency 95 and bispectral index.
The return or Poincaré plot is a non-linear analytical approach in a two-dimensional plane, where a timed signal is plotted against itself after a time delay. Its scatter pattern reflects the randomness and variability in the signals. ⋯ The regression analysis showed a tight linear regression equation with a coefficient of determination (R(2) ) value of 0.904 (p < 0.0001) between the Poincaré index (SD1/SD2) and SEF95, and a moderate linear regression equation between SD1/SD2 and bispectral index (R(2) = 0.346, p < 0.0001). Quantification of the Poincaré plot tightly correlates with SEF95, reflecting anaesthesia-dependent changes in electroencephalogram oscillation.
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Randomized Controlled Trial
Use of hyaluronidase as an adjuvant to ropivacaine to reduce axillary brachial plexus block onset time: a prospective, randomised controlled study.
Hyaluronidase 100 IU/mL when added to ropivacaine speeds onset of axillary nerve blockade.
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Randomized Controlled Trial Comparative Study
Simulation-based teaching versus point-of-care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study.
In recent years, the use of transoesophageal echocardiography has increased in anaesthesia and intensive care. We explored the impact of two different teaching methods on the ability of echocardiography-naïve subjects to identify cardiac anatomy associated with the 20 standard transoesophageal echocardiography imaging planes, and assessed trainees' satisfaction with these methods of training. Fifty-two subjects were randomly assigned to one of two groups: a simulation-based and a theatre-based teaching group. ⋯ Subjects in simulation- and theatre-based teaching groups scored 40% (30-40 [20-50])% and 35% (30-40 [15-55])% in the pre-test, respectively (p = 0.52). Following echocardiography teaching, subjects within both groups improved upon their pre-test knowledge (p < 0.001). Subjects in the simulation-based teaching group significantly outperformed their theatre-based group counterparts in the post-intervention test (p = 0.0002).
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Both the American Society of Anesthesiologists and the UK NAP4 project recommend that an unspecified pre-operative airway assessment be made. However, the choice of assessment is ultimately at the discretion of the individual anaesthesiologist. We retrieved a cohort of 188 064 cases from the Danish Anaesthesia Database, and investigated the diagnostic accuracy of the anaesthesiologists' predictions of difficult tracheal intubation and difficult mask ventilation. ⋯ Likewise, difficult mask ventilation was unanticipated in 808 of 857 (94%) cases, and when anticipated (218 cases), difficult mask ventilation actually occurred in 49 (22%) cases. We present a previously unpublished estimate of the accuracy of anaesthesiologists' prediction of airway management difficulties in daily routine practice. Prediction of airway difficulties remains a challenging task, and our results underline the importance of being constantly prepared for unexpected difficulties.