British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: Performance of three pharmacokinetic-dynamic models.
In the ideal pharmacokinetic-dynamic (PK-PD) model for calculating the predicted effect-site concentration of propofol (Ce(PROP)), for any Ce(PROP), the corresponding hypnotic effect should be constant. We compared three PK-PD models (Marsh PK with Shüttler PD, Schnider PK with fixed ke0, and Schnider PK with Minto PD) in their ability to maintain a constant bispectral index (BIS), while using the respective effect-site-controlled target-controlled infusion (TCI) algorithms. ⋯ Targeting Ce(PROP) at which patients lose consciousness with effect-site-controlled TCI does not translate into an immediate constant effect.
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Randomized Controlled Trial Comparative Study
Teaching airway management to novices: a simulator manikin study comparing the 'sniffing position' and 'win with the chin' analogies.
The 'sniffing position' is widely promoted for teaching airway positioning before intubation, but whether this analogy results in novices placing the head and neck appropriately has not been evaluated. We compared performance following the sniffing position instructions with an alternate analogy, 'win with the chin'. We also compared performance following simple anatomic instructions and no instructions. ⋯ The 'win with the chin' analogy resulted in adequate airway positioning significantly more often than the 'sniffing position' or control. It also maintained atlanto-occipital extension compared with anatomic instructions. Overall, 'win with the chin' was a superior teaching analogy and could replace the 'sniffing position' analogy.