Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 2011
Review Comparative StudyA systematic review of third-generation hydroxyethyl starch (HES 130/0.4) in resuscitation: safety not adequately addressed.
Hydroxyethyl starches (HES) are widely used for intravascular volume therapy in surgical, emergency, and intensive care patients. There are safety concerns with regard to coagulopathy, renal failure, pruritus, tissue storage, and mortality. Third-generation HES 130/0.4 is considered to have an improved risk profile. A common rationale for the use of HES is the belief that 3 to 4 times more crystalloid than colloid volume is needed to achieve similar hemodynamic end points. Our goal was to assess whether published studies on HES 130/0.4 resuscitation are sufficiently well designed to draw conclusions about the safety of this compound. In addition, we wanted to assess crystalloid-to-colloid fluid ratios in studies with goal-directed fluid regimen. ⋯ In summary, the extent of fluid load reduction that can be achieved by HES 130/0.4 is overestimated. Use of older HES solutions may be associated with serious side effects, and clinicians should be aware that there is no convincing evidence that third-generation HES 130/0.4 is safe in surgical, emergency, or intensive care patients despite publication of numerous clinical studies.
-
Anesthesia and analgesia · Mar 2011
Randomized Controlled Trial Comparative StudyA comparison of the classic and a modified laryngeal mask airway (OPLAC™) in adult patients.
A modified disposable laryngeal mask airway (LMA) (Oro-Pharyngo-Laryngeal Airway Cap, OPLAC™) was developed in our department. In this study, we compared the performance of the LMA Classic™ with that of the OPLAC. ⋯ Both devices have comparable airflow resistance and are easy to insert. The OPLAC requires less insertion time, has less variation on insertion time, fits better into the laryngopharynx, is less likely to cause gastric insufflations, and has a higher sealing pressure.