British journal of anaesthesia
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Randomized Controlled Trial
Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq laryngoscopes.
The Airtraq laryngoscope is designed to allow visualization of the glottis without alignment of the oral, pharyngeal, and laryngeal axes. We hypothesized that this new airway device would facilitate tracheal intubation of morbidly obese patients. We compared tracheal intubation performance of standard Macintosh laryngoscope with the Airtraq laryngoscope in morbidly obese patients. ⋯ In this study, the Airtraq laryngoscope shortened the duration of tracheal intubation and prevented reductions in arterial oxygen saturation in morbidly obese patients.
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Randomized Controlled Trial
Comparative effects of propofol vs dexmedetomidine on cerebrovascular carbon dioxide reactivity in patients with septic shock.
The use of sedative drugs is reportedly related to altered cerebrovascular CO2 reactivity. The present study examined the comparative effects of propofol vs dexmedetomidine on cerebrovascular CO2 reactivity in patients with septic shock. ⋯ This study showed that cerebrovascular CO2 reactivity was lower under dexmedetomidine sedation than under propofol sedation during almost identical sedation in patients with septic shock.
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We present a 15-patient series of awake 'off-pump' [without cardiopulmonary bypass (CPB)] coronary artery bypass graft surgery, facilitated by thoracic epidural analgesia (TEA) and femoral nerve block. ⋯ Combined TEA and femoral block is a novel anaesthetic technique, and is feasible, for cardiac surgery. However, certain technical limitations need to be overcome to evaluate the full potential of 'awake' cardiac surgery.
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Little research has been performed on designing appointment systems for the preoperative assessment clinic (PAC). We aimed to investigate how two organizational planning difficulties, (i) long access times and (ii) long waiting times, could be analysed systematically. ⋯ This study shows that a simulation model is a helpful tool to determine the capacity needed to achieve and to maintain a proposed service level for access times and waiting times. In addition, waiting times at the PAC can be reduced by making the reserved consultation time dependent on patients' ASA physical status.
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The effects of vasoactive substances on cerebral haemodynamics are not fully known. We studied the effects of norepinephrine and glyceryl trinitrate (GTN) on cerebral haemodynamics in healthy volunteers. ⋯ Norepinephrine, despite increasing arterial pressure, did not increase the eCPP. The eCPP increased significantly with GTN, despite decreased MAP. Cerebral vascular tone is an important determinant of CPP during pharmacologically induced changes in arterial pressure.