British journal of anaesthesia
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Randomized Controlled Trial
High concordance between expert anaesthetists' actions and advice of decision support system in achieving oxygen delivery targets in high-risk surgery patients.
Goal-directed therapy has a secure place in perioperative care. Algorithms are based on Starling's law of the heart, notwithstanding that this does not numerically define volume or heart performance variables. These have been developed based on a Guytonian view of the circulation and are implemented in a computerized decision support system (Navigator™). We studied the feasibility and performance of the graphical display of the system in an intervention and a control group of patients undergoing major abdominal surgery. ⋯ In experienced hands, the addition of a graphical display for haemodynamic guidance resulted in a similar time in target and averaged standardized difference. The haemodynamic guidance system should be explored in a comparative study to anaesthesia management without guidance.
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Intubation is one of the most important anaesthetic skills. We developed a robotic intubation system (Kepler intubation system, KIS) for oral tracheal intubation. ⋯ We present the first human testing of a robotic intubation system for oral tracheal intubation. The success rate was high at 91%. Future studies are needed to assess the performance and safety of such a system.
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Randomized Controlled Trial
Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index.
I.V. lidocaine is increasingly used as an adjuvant during general anaesthesia. The aim of this study was to evaluate the effect of i.v. lidocaine in reducing propofol anaesthetic requirements during total i.v. anaesthesia (TIVA) maintenance and to evaluate its effect on early recovery from anaesthesia. ⋯ I.V. lidocaine reduces propofol requirements during the maintenance phase of TIVA, particularly during surgical stimulation. This sparing effect is associated with an increased time to extubation. Owing to its effect on early recovery from anaesthesia, i.v. lidocaine should be taken into account when used as a component of i.v. anaesthesia.
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The aim of the study was to determine whether the fibrinogen level at diagnosis of postpartum haemorrhage (PPH) is associated with the severity of bleeding. ⋯ The fibrinogen level at PPH diagnosis is a marker of the risk of aggravation and should serve as an alert to clinicians.