British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of the performance of four laryngoscopes in a high-fidelity simulator using normal and difficult airway.
Novel laryngoscopes may demonstrate advantages over the traditional Macintosh laryngoscope for difficult airways. Our study compared Glidescope laryngoscope, Bonfils fibrescope, and CTrach intubating laryngeal mask airway with the Macintosh laryngoscope in a simulated normal and difficult airway, considering the additional effect of previous intubation experience. ⋯ In this study, the Macintosh laryngoscope outperformed the other devices. However, the Glidescope was considered easy to use regardless of previous experience and was the preferred device for the simulated difficult airway.
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Cognitive overload has been recognized as a significant cause of error in industries such as aviation, and measuring mental workload has become a key method of improving safety. The aim of this study was to pilot the use of a new method of measuring mental workload using a previously published study design. ⋯ These findings confirm the importance of mental workload to the performance of anaesthetists, and suggest that raised mental workload is likely to be a common problem. Although further studies are required, the method described may provide a useful method for the measurement of the mental workload of anaesthetists.
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Review Meta Analysis
Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials.
Postoperative gastrointestinal (GI) dysfunction is one of the most frequent complications in surgical patients. Most cases are associated with episodes of splanchnic hypoperfusion due to hypovolaemia or cardiac dysfunction. It has been suggested that perioperative haemodynamic goal-directed therapy (GDT) may reduce the incidence of these complications in cardiac surgery, and other surgery, but clear evidence is lacking. ⋯ Treatment did not reduce hepatic injury rate (OR, 0.54; 95% CI, 0.19-1.55). Quality sensitive analyses confirmed the main overall results. In patients undergoing major surgery, GDT, by maintaining an adequate systemic oxygenation, can protect organs particularly at risk of perioperative hypoperfusion and is effective in reducing GI complications.
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Randomized Controlled Trial Comparative Study
Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy.
The administration of low-dose bupivacaine can limit the distribution of spinal block to reduce adverse haemodynamic effects. Intrathecal opioids can enhance analgesia in combination with subtherapeutic doses of local anaesthetics. We aimed at comparing the efficacy of intrathecal fentanyl and sufentanil with low-dose diluted bupivacaine for transurethral prostatectomy (TURP) in elderly patients. ⋯ Low-dose diluted bupivacaine with fentanyl 25 microg or sufentanil 5 microg can provide adequate anaesthesia without haemodynamic instability for TURP in elderly patients. However, sufentanil was superior to fentanyl in the quality of the spinal block produced.
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The objective of the present study was to investigate the effects of increasing doses of norepinephrine (NE) with or without arginine-vasopressin (AVP) on intestinal oxygen supply and jejunal mucosal tissue oxygen tension in an acute endotoxic pig model. ⋯ Both NE and NE+AVP improved global haemodynamics and systemic oxygen transport variables when compared with control animals in an acute endotoxic pig model. NE improved jejunal PO2muc at all dosages. NE effects were significantly blunted by simultaneous administration of AVP.