British journal of anaesthesia
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Comparative Study
Monitoring non-invasive cardiac output and stroke volume during experimental human hypovolaemia and resuscitation.
Multiple methods for non-invasive measurement of cardiac output (CO) and stroke volume (SV) exist. Their comparative capabilities are not clearly established. ⋯ LTI, EBI, and MF were able to track progressive hypovolaemia. PP decreased during hypovolaemia but its magnitude of reduction underestimated reductions in SV. PP and MF were inferior for the identification of resuscitation.
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Calls for reform to postgraduate medical training structures in the UK have included suggestions that training should foster excellence and not simply ensure competence. ⋯ The achievement of excellence in anaesthesia is likely to depend on the successful interplay of individuals' personal qualities and the environment in which they work. Thus, not only trainees but also educational supervisors, heads of departments, and those responsible for organizing training systems all have a part to play in the encouragement of excellence.
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Comparative Study
Comparison of three cuffed emergency percutaneous cricothyroidotomy devices to conventional surgical cricothyroidotomy in a porcine model.
Emergency cricothyroidotomy is a potentially life-saving procedure in the 'cannot intubate cannot ventilate (CICV)' scenario. Although surgical cricothyroidotomy remains the technique recommended in many 'CICV' algorithms, the insertion of a tracheostomy as a cannula over a trocar, or using the Seldinger method, may have advantages as they are more familiar to the anaesthetist. We compared the utility of three cuffed cricothyroidotomy devices: cuffed Melker®, Quicktrach 2®, and PCK® devices, with surgical cricothyroidotomy. ⋯ The Melker® and Quicktrach 2® devices appear to hold particular promise as alternatives to surgical cricothyroidotomy. Further studies, in more clinically relevant models, are required to confirm these initial positive findings.
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Entropy™, an anaesthetic EEG monitoring method, yields two parameters: State Entropy (SE) and Response Entropy (RE). SE reflects the hypnotic level of the patient. RE covers also the EMG-dominant part of the frequency spectrum, reflecting the upper facial EMG response to noxious stimulation. We studied the EEG, EMG, and Entropy values before and after skin incision, and the effect of rocuronium on Entropy and EMG at skin incision during sevoflurane-nitrous oxide (N₂O) anaesthesia. ⋯ During sevoflurane-N₂O anaesthesia, both EEG and EMG arousals were seen. β and δ arousals had opposite effects on the Entropy values. The EMG arousal was abolished by rocuronium at the train of four level 0/4.
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The objective of this study was to determine the relationship between perioperative complications and the severity of obstructive sleep apnoea (OSA) in patients undergoing bariatric surgery who had undergone preoperative polysomnography (PSG). ⋯ In obese patients evaluated before operation by PSG before bariatric surgery and managed accordingly, the severity of OSA, as assessed by the AHI, was not associated with the rate of perioperative complications. These results cannot determine whether unrecognized and untreated OSA increases risk.