British journal of anaesthesia
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Comment Letter Comparative Study
Effect of rocuronium compared with succinylcholine on IOP.
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Randomized Controlled Trial Comparative Study Clinical Trial
High frequency jet ventilation and gas trapping.
We have compared three types of high frequency jet ventilation (HFJV) with conventional positive pressure ventilation in patients recovering from elective coronary artery bypass surgery. Twelve patients were allocated randomly to receive HFJV at ventilatory frequencies of 60, 100, 150 and 200 bpm from a standard jet ventilator at either the proximal or distal airway (HFJV.p and HFJV.d), or from a valveless high frequency jet ventilator acting as a pneumatic piston (VPP). Trapped gas volume (Vtr), cardiac index (CI) and right ventricular ejection fraction (RVEF) were measured. ⋯ The same three types of HFJV were compared using a lung model with variable values of compliance and resistance, to assess the impact of lung mechanics on gas trapping (Vtr, ml). Lung model compliance (C) was set at 50 or 25 ml cm H2O-1 and resistance (R) at 5 or 20 cm H2O litre-1 s, where values of 50 and 5, respectively, are normal. Vtr increased with ventilatory frequency for all types of jet ventilation (P < 0.05), varying with the type of jet ventilation used (P < 0.05).
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Sedation is an important component of patient comfort in the intensive care unit (ICU), especially in those undergoing mechanical ventilation. Sedation that is too light or too deep can have important consequences, and therefore assessment of the degree of sedation should be an important part of patient management. Although there are many methods available to assess the degree of sedation, none is ideal. ⋯ There were no significant differences in mean or highest levels between patients in the two phases (mean 2.89 (SD 0.11) vs 2.67 (0.13), P = 0.22; highest 3.16 (0.11) vs 3.10 (0.14), P = 0.78). However, the lowest level was significantly greater in patients in the second phase than in those in the first phase (2.61 (0.11) vs 2.16 (0.13); P = 0.011), indicating that the number of patients with excessive sedation was significantly reduced with the introduction of this scale. Thus the use of this scale can have a real clinical impact for patients undergoing mechanical ventilation, principally by avoiding excessive sedation.
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Comment Letter Randomized Controlled Trial Clinical Trial
Opioid-induced pruritus: repeated vs single dose ondansetron administration in preventing pruritus after intrathecal morphine.