Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Oct 2017
Observational StudyChildren with challenging airways: What about GlideScope® video-laryngoscopy?
GlideScope® video-laryngoscopy is becoming increasingly used, including in paediatrics. However, to date, very few data are available on efficiency during situations involving difficult intubation. Our objective was to describe the usefulness of the GlideScope® in children with presumed challenging airway criteria. ⋯ In children with challenging airways, GlideScope® video-laryngoscopy resulted in a significant improvement of the glottic view with an excellent success rate and satisfactory time to intubation. How these devices are to be positioned in difficult airway management algorithms and guidelines remain to be defined.
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Anaesth Crit Care Pain Med · Oct 2017
Learning curve for real-time ultrasound-guided percutaneous tracheostomy.
The objective of this study was to demonstrate and quantify the ultrasound-guided percutaneous tracheostomy (UPDT) learning curve in a single team since the first UPDT. ⋯ Our study demonstrated that UPDT is associated with a fairly long learning curve. At least 50 procedures are necessary to perform UPDT with an acceptable complication rate and procedure time.
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Anaesth Crit Care Pain Med · Aug 2017
Observational StudyA targeted remifentanil administration protocol based on the analgesia nociception index during vascular surgery.
The intraoperative modulation of opioids continues to be based on clinical signs. This may result in adverse events such as sympathetic reactivity or opioid-induced hyperalgesia. Recently, the Analgesia/Nociception Index (ANI), a non-invasive 0-100 index derived from heart rate variability analysis, has been proposed for nociception assessment. However, the ability of the ANI to adequately guide intraoperative opioid administration has never been demonstrated. We designed a prospective study to evaluate the ability of the ANI to guide remifentanil administration in vascular surgery. ⋯ This prospective study demonstrated that the ANI can be used to adequately guide intraoperative remifentanil administration during vascular surgery. Such guidance resulted in low remifentanil consumption, low postoperative pain rates and low opioid rescue analgesia.
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Anaesth Crit Care Pain Med · Aug 2017
Observational StudyPostoperative complications after craniotomy for brain tumor surgery.
After elective craniotomy for brain tumour surgery, patients are usually admitted to an intensive care unit (ICU) for monitoring. Our goal was to evaluate the incidence and timing of neurologic and non-neurologic postoperative complications after brain tumour surgery, to determine factors associated with neurologic events and to evaluate the timing and causes of ICU readmission. ⋯ Postoperative complications, especially PONV, are frequent after brain tumour surgery. Moreover, 16% of patients presented a neurological complication, probably justifying the ICU postoperative stay for early detection. The absence of preoperative motor deficit and intraoperative bleeding seems to predict postoperative neurologic complications. Finally, patients may present complications after ICU discharge, especially patients with fossa posterior surgery, suggesting that ICU hospitalization may be longer in this type of surgery.