British journal of anaesthesia
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Clinical Trial
Fentanyl decreases end-expiratory lung volume in patients anaesthetized with sevoflurane.
In patients breathing spontaneously during anaesthesia, expiratory muscle activity can be a prominent feature. This activity is triggered or exaggerated by opioid administration, which causes a prompt increase in intra-abdominal pressure. The effect of this increased expiratory activity on end-expiratory lung volume is not described. ⋯ During sevoflurane anaesthesia, fentanyl causes a rapid reduction in functional residual capacity. This is caused by increased activity of expiratory muscles and an increase in intra-abdominal pressure.
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Despite a growing recognition of the role of human error in anaesthesia, it remains unclear what should be done to mitigate its effects. We addressed this issue by using task analysis to create a systematic description of the behaviours that are involved during anaesthesia, which can be used as a framework for promoting good practice and highlight areas of concern. ⋯ We have demonstrated the value of task analysis in improving anaesthetic practice. Task analysis facilitates the identification of relevant human factors issues and suggests ways in which these issues can be addressed. The output of the task analysis will be of use in focusing future interventions and research in this area.
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Randomized Controlled Trial
Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia.
This randomized, double-blind, prospective study was undertaken to evaluate the effects of magnesium sulphate on anaesthetic requirements and postoperative analgesia in patients undergoing total i.v. anaesthesia (TIVA). ⋯ I.v. magnesium sulphate during TIVA reduced rocuronium requirement and improved the quality of postoperative analgesia.
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Review Meta Analysis
Closed tracheal suction systems for prevention of ventilator-associated pneumonia.
We have assessed the evidence that closed tracheal suction systems (TSS) prevent ventilator-associated pneumonia (VAP), using a meta-analysis of randomized controlled trials (RCTs). We searched PubMed and Cochrane databases to identify RCTs that compared closed with open TSS for the management of mechanically ventilated (MV) patients. Nine RCTs were included in the meta-analysis. ⋯ The compared groups did not differ with respect to mortality (OR=1.04, 95% CI 0.78-1.39) or intensive care unit (ICU) length of stay [two RCTs: 12.3 (sd 1.1) vs 11.5 (1.4) days and 15.6 (13.4) vs 19.9 (16.7) days]. Suctioning with closed systems was associated with longer MV duration (weighted mean differences: 0.65 days, 95% CI 0.28-1.03) and higher colonization of the respiratory tract (OR=2.88, 95% CI 1.50-5.52) than open TSS. The available evidence suggests that closed as opposed to open TSS usage did not provide any benefit on VAP incidence, mortality, or ICU stay of MV patients.