Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Oct 2015
Randomized Controlled TrialInfluence of needle diameter on spinal anaesthesia puncture failures for caesarean section: A prospective, randomised, experimental study.
Spinal anaesthesia represents the technique of choice for elective caesarean section. The purpose of this study was to compare the puncture failure rates with 25, 26 or 27 gauge (G) pencil-point, Whitacre type (with introducer) needles during spinal anaesthesia for caesarean section. ⋯ This prospective study showed that puncture failures occur less frequently with the use of 25G or 26G pencil-point needles as compared to 27G needles, probably due to the higher flexibility of the latter. This characteristic was demonstrated in vitro, in a reproducible model. This experiment suggests that a 26G pencil-point needle is the optimal gauge for performing spinal anaesthesia for scheduled caesarean sections.
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Anaesth Crit Care Pain Med · Oct 2015
Observational StudyUse of near-infrared spectroscopy in predicting response to intravenous fluid load in anaesthetized infants.
The prediction of fluid responsiveness in paediatrics and infants remains problematic. We sought to test the validity of the measurement of StcO2 as a predictive parameter of fluid responsiveness in infants less than one year old during non-cardiac surgery. ⋯ NIRS appears to be an interesting additional tool for predicting an increase of blood pressure in response to intraoperative fluid challenge in infants less than one year old.
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Anaesth Crit Care Pain Med · Oct 2015
Comparative StudyA survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy.
Postoperative pain, nausea and vomiting are frequent symptoms after tonsillectomy. There have been controversies concerning the advantages and drawbacks of different analgesics in this setting, especially non-steroidal anti-inflammatory drugs, because of potential side effects. We have evaluated the effectiveness and safety of a shift from prednisolone to ibuprofen for postoperative analgesia after tonsillectomy. ⋯ The administration of ibuprofen compared to prednisolone improves postoperative comfort in children undergoing ambulatory tonsillectomy without increasing the incidence of side effects.
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Anaesth Crit Care Pain Med · Oct 2015
Case ReportsTransient neurological deficit due to a misplacement of central venous catheter despite ultrasound guidance and ultrasound assistance.
Central venous catheters (CVC) are frequently used in intensive care units (ICU), with a low incidence of complications, most of them being of mechanical origin and occurring during the insertion of the catheter. To avoid such complications, "ultrasound guidance" and "ultrasound assistance" are recommended. Nevertheless, even with trained and experienced physicians, mechanical complications of IJV access such as carotid punctures are still reported. ⋯ The cervical and thoracic CT scan showed a transfixing path of the catheter from the left IJV into the left common carotid artery, with distal extremity of the catheter localized in the ascending aorta. The catheter was removed, and thereafter the neurological deficit immediately and definitely disappeared. Onset of a neurological deficit after CVC insertion into the IJV, regardless the time of occurrence after the procedure, should suggest complication due to the CVC insertion, even if procedure was uneventful and chest radiography confirmed the apparent accurate position of CVC.
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Anaesth Crit Care Pain Med · Oct 2015
A retrospective study about cerebral near-infrared spectroscopy monitoring during paediatric cardiac surgery and intra-operative patient blood management.
Cerebral non-invasive monitoring of oxygen saturation by near-infrared spectroscopy (rSO2) during paediatric cardiac surgery is supposed to decrease the risk of neurological complications. Since haemoglobin level is one of the factors changing rSO2, we aimed to explore if rSO2 monitoring influences intra-operative RBC (red blood cell) transfusion threshold and volumes, as well as the duration of ICU stay. ⋯ rSO2 monitoring changed our transfusion strategy with an earlier transfusion but a reduced total RBC volume and decreased the length of ICU stay.