European journal of anaesthesiology
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Multicenter Study
Quality of pain management in the emergency department: results of a multicentre prospective study.
The purpose of this study was to evaluate pain management in a large sample of emergency departments (EDs) and identify potential corrective measures. METHOLOGY: A multicentre prospective study was performed in 50 EDs participating in a national quality improvement programme. The rate of inclusion was determined a priori in each ED. Patients were questioned about their pain and pain intensity was assessed by a visual analogue scale. A bivariate and a multivariate analysis were conducted to identify the criteria associated with inadequate pain management. ⋯ This multicentre study conducted on a nationwide scale shows that pain relief can be improved in the ED. Pain intensity is not sufficiently reassessed, analgesics are underutilised, morphine sulfate is rarely used and delay in treatment is common. Reasons for inadequate analgesia were identified in order to identify relevant corrective measures to improve quality of pain management in the ED.
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Multicenter Study
A simplified risk score to predict difficult intubation: development and prospective evaluation in 3763 patients.
Despite the presence of numerous preoperative tests to predict a difficult airway, there is no reliable bedside method. The aim of this study was to create and verify a simplified risk model with an acceptable discriminating power. ⋯ The new simplified multivariate risk score for difficult intubation may prove to be useful in clinical practice for predicting a difficult airway. Presence of upper front teeth, a history of difficult intubation, any Mallampati status different from '1' and equal to '4' and mouth opening less than 4 cm are independent risk factors for difficult endotracheal intubation. With each of these risk factors, the likelihood increases from 0 (when no risk factor is present) to 17% (when four or five factors are present).
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized simultaneous comparison of acceleromyography with a peripheral nerve stimulator for assessing reversal of rocuronium-induced neuromuscular blockade with sugammadex.
We investigated the relationship between acceleromyography and a peripheral nerve stimulator for measuring reversal in patients administered sugammadex following rocuronium. ⋯ T4 is detected at similar times when measured by a peripheral nerve stimulator or acceleromyography following sugammadex 4.0 mg kg administration 15 min after rocuronium. The mean interval between T4 reappearance (peripheral nerve stimulator) and recovery to a train-of-four ratio of at least 0.9 (acceleromyography) was 0.8 min. These findings provide guidance for evaluating the reversal effect of sugammadex in clinical situations.
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Randomized Controlled Trial Multicenter Study Comparative Study
Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial.
Sugammadex, a modified gamma-cyclodextrin, is a selective relaxant-binding agent designed to reverse the effects of the steroidal neuromuscular blocking agents rocuronium or vecuronium. This study compared the efficacy of sugammadex and neostigmine for reversal of neuromuscular blockade induced by rocuronium for facilitating elective surgery. ⋯ Sugammadex achieved significantly faster recovery of neuromuscular function after rocuronium to a TOF ratio of 0.9 compared with neostigmine (Clinicaltrials.gov identifier: NCT00451217).
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Randomized Controlled Trial Multicenter Study
Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients.
To examine the kinetics of volume loading with crystalloid and colloid infusions in critically ill patients after major surgery, using the pulse contour cardiac output (PiCCO) monitoring technique. ⋯ In postoperative hypovolaemic patients, lactated Ringer's solution can significantly improve haemodynamics at the end of volume loading, but this effect completely disappears at 120 min. Ten millilitres per kilogram of colloid bolus (especially HES) improved the haemodynamics at 120 min; however, this was by only 5-25% compared with baseline. The colloids caused significantly larger AUCs than lactated Ringer's solution, but only in the cardiac index, GEDVI and DO2I, plus human albumin in the SVV.