European journal of anaesthesiology
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Randomized Controlled Trial Multicenter Study
Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway: A multicentre randomised controlled trial.
What did they do?
Kowark and friends randomised 343 patients across four German hospitals to receive desflurane, sevoflurane or propofol for maintenance anesthesia using a laryngeal airway for surgery expected to be up to 2 hours.
And they found?
There was no difference in airway reactions among the three groups, and the desflurane patients emerged (statistically) significantly faster.
Hang on...
But the difference in emergence times was, i) at most only 2 minutes, and ii) was a surrogate marker for what actually matters – when a patient leaves the PACU or hospital – which wasn't reported.
Additionally, the study protocol very prescriptively defined when volatiles were decreased (50% at 5 min before expected surgical finish) and ceased – the same for both Des and Sevo. Yet it is common practice to begin weaning Sevo earlier than Des if trying to achieve comparable emergence.
Could this even be applied to my patients?
Probably not. Unless you are in the habit of using remifentanil infusions (0.15 mcg/kg/min) for surgery that almost certainly does not justify its use and have access to uniquely European analgesics piritramide and metamizole.
The elephant in the room...
Why do we persist in trying to find new justifications for desflurane, given its expense and high environmental costs? (And for that matter, remifentanil?!).
This study demonstrates the well known faster pharmacokinetics of desflurane during an unnecessarily complex laryngeal mask anesthetic, and yet adds little to meaningful clinical outcomes.
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Randomized Controlled Trial Multicenter Study
For beginners in anaesthesia, self-training with an audiovisual checklist improves safety during anaesthesia induction: A randomised, controlled two-centre study.
Beginners in residency programmes in anaesthesia are challenged because working environment is complex, and they cannot rely on experience to meet challenges. During this early stage, residents need rules and structures to guide their actions and ensure patient safety. ⋯ The use of an audiovisual self-training checklists improves safety-relevant behaviour in the early stages of a residency training programme in anaesthesia.
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Multicenter Study Observational Study
Patient factors and outcomes associated with the withdrawal or withholding of life-sustaining therapies in mechanically ventilated brain-injured patients: An observational multicentre study.
Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. ⋯ Using a nationwide cohort of brain-injured patients, we observed a high proportion of deaths associated with an end-of-life decision. Older age and several disease severity factors were associated with the decision to WWLS.
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Randomized Controlled Trial Multicenter Study
Standardised noxious stimulation-guided individual adjustment of remifentanil target-controlled infusion to prevent haemodynamic responses to laryngoscopy and surgical incision: A randomised controlled trial.
The surgical plethysmographic index (SPI) is one of the available indexes of the nociception-antinociception (NAN) balance. Individually adjusting the NAN balance to prevent somatic responses to noxious stimulation remains a challenge. ⋯ Further research is needed to define the best NANCAL stimulus and the best remifentanil correcting scheme to help individualised tailoring of antinociception for each specific subpopulation of surgical patients.
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Multicenter Study Comparative Study Observational Study
Blood glucose concentrations in prehospital trauma patients with traumatic shock: A retrospective analysis.
Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce. ⋯ In adult trauma patients, low and high blood glucose concentrations were more common in patients with traumatic shock. Prehospital blood glucose concentration measurements in addition to common vital parameters may help identify patients at risk of traumatic shock.