Anaesthesia and intensive care
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Anaesth Intensive Care · May 2008
Randomized Controlled Trial Comparative StudyComparison of the laryngeal mask (LMA) and laryngeal tube (LT) with the perilaryngeal airway (cobraPLA) in brief paediatric surgical procedures.
We compared the laryngeal mask airway (LMA) and the laryngeal tube (LT) with the perilaryngeal airway (CobraPLA, PLA) in anaesthetised, paralysed children having brief surgical procedures. After obtaining informed consent, 90 paediatric ASA Status 1 and 2 patients awaiting short surgical procedures were randomised to have their airways managed with an LMA, LT or PLA. Anaesthesia was induced with sevoflurane (2.5 to 4%) and muscle paralysis with mivacurium (0.2 mg/kg intravenously). ⋯ The number and type of airway interventions to achieve an effective airway were comparable. When the airways were removed, positive blood traces were noted on 20% of the LMAs, 20% of the PLAs and 10% of the LTs. Haemodynamic, ventilation and oxygenation variables throughout the surgery were similar with LMA, LT and PLA and there were no significant differences in insertion time or signs or symptoms of mucosal trauma when these devices were used in paralysed children.
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Anaesth Intensive Care · May 2008
Randomized Controlled Trial Comparative StudyHaemodynamic and Bispectral index response to insertion of the Streamlined Liner of the Pharynx Airway (SLIPA): comparison with the laryngeal mask airway.
The newly developed supralaryngeal airway Streamlined Liner of the Pharynx Airway (SLIPA) has been compared successfully to the LMA, but the haemodynamic response to its insertion has not been evaluated in a randomised study. We compared haemodynamic and Bispectral index (BIS) responses to insertion of the SLIPA with classic LMA after standardising the anaesthetic technique using BIS to monitor and control the anaesthetic depth. One hundred patients were randomised to receive either a classic LMA or SLIPA following induction with fentanyl and propofol titrated to a target BIS of 40 and compared heart rate, mean arterial pressure and BIS responses to insertion. ⋯ BIS increased significantly (P<0.05) at one, two, three, four and five minutes following insertion of both the devices, but there was no significant difference between the groups. There was a significantly higher (P=0.001) incidence of blood on the device with the SLIPA (20/50 vs. 6/50 with LMA). Thus, insertion of SLIPA causes significantly higher blood-pressure response but similar BIS response compared to the LMA.
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Anaesth Intensive Care · May 2008
Identification of genetic mutations in Australian malignant hyperthermia families using sequencing of RYR1 hotspots.
Advances in analysis of the RYR1 gene (which encodes the skeletal muscle ryanodine receptor) show that genetic examination is a useful adjunct to the in vitro contracture test in the diagnosis of malignant hyperthermia, as defects in RYR1 have been shown to be responsible for malignant hyperthermia susceptibility. DNA from 34 malignant hyperthermia susceptible individuals and four malignant hyperthermia equivocal subjects was examined using direct sequencing of 'hot-spots' in the RYR1 gene to identify mutations associated with malignant hyperthermia. Seven different causative mutations (as defined by the European Malignant Hyperthermia Group) in nine malignant hyperthermia susceptible individuals were identified. ⋯ Based on the number of relatives presenting to our unit in the study period, the muscle biopsy rate would have decreased by 25%. That we only identified a genetic defect in RYR1 in 47% of in vitro contracture test positive individuals suggests that there are other areas in RYR1 where pathogenic mutations may occur and that RYR1 may not be the sole gene associated with malignant hyperthermia. It may also reflect a less than 100% specificity of the in vitro contracture test.
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Anaesth Intensive Care · May 2008
The accuracy of reporting of general anaesthesia for childbirth: a validation study.
Administrative population health data, such as hospital discharge data, are a potentially valuable resource for determining anaesthesia and analgesia use in childbirth at a population level. However the reliability of general anaesthesia reporting is unknown. This study aimed to determine the accuracy of the reporting of peripartum general anaesthesia in single and linked population health data. ⋯ Limiting analysis to caesarean sections resulted in very accurate identification of general anaesthesia for delivery (sensitivity 97.0%, specificity 99.8%) while limiting to vaginal births was moderately accurate for identifying postpartum general anaesthesia (sensitivity 73.2%, specificity 99.8%). General anaesthesia for delivery is reported with a high level of accuracy in birth and linked birth-hospital data, but not in hospital discharge data alone. Population health data are a reliable source for examining general anaesthesia for delivery.
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Anaesth Intensive Care · May 2008
Noradrenaline use is not associated with extubation failure in septic patients.
Standard clinical practice recommends minimal doses of vasoactive drugs during weaning of patients from mechanical ventilation. However there are currently no clinical data to inform clinicians about whether the use of noradrenaline during weaning predisposes to weaning failure. The objective of this study was to evaluate whether the necessity of the vasopressor noradrenaline in mechanically ventilated patients recovering from septic shock changed the extubation outcome. ⋯ Arterial blood gases and ventilatory and haemodynamic parameters were similar in all patients regardless of weaning success. We did not find that the use of noradrenaline at the time of weaning was associated with extubation failure. Low doses of noradrenaline may not preclude weaning from mechanical ventilation.