Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2005
Randomized Controlled Trial Multicenter StudyRecovery from bispectral index-guided anaesthesia in a large randomized controlled trial of patients at high risk of awareness.
Electroencephalographic monitors of anaesthetic depth are reported to assist anaesthetists in reducing recovery times. We explored the effect of bispectral index (BIS) monitoring on recovery times in a double-blind, randomized controlled trial of 2,463 patients at high risk of awareness. Patients were randomized to BIS-guided anaesthesia or routine care. ⋯ In multivariate models, BIS monitoring, female gender, lower American Society of Anesthesiologists' physical status and shorter duration of anaesthesia predicted faster time to eye-opening after anaesthesia, and faster time to post-anaesthesia care unit discharge. BIS monitoring did not affect times to tracheal extubation among patients admitted to the intensive care unit. We conclude that BIS monitoring has statistically significant, but clinically modest, effects on recovery times in high risk surgical patients.
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Anaesth Intensive Care · Jun 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparative study between propofol in a long-chain triglyceride and propofol in a medium/long-chain triglyceride during sedation with target-controlled infusion.
This study was performed to compare the pharmacological characteristics of propofol in an emulsion of both medium- and long-chain triglycerides (MCT/LCT) with those of propofol in an LCT emulsion, by measuring the sedative level and the plasma concentration of propofol during sedation using a target-controlled infusion (TCI) technique. Forty ASA 1 or 2 adult patients who required spinal anaesthesia for surgery were enrolled in this study. The patients were divided into two groups: a propofol LCT group (n = 20) and a propofol MCT/LCT group (n = 20). ⋯ There were no significant differences between the two groups in BIS index or in plasma concentration of propofol at each predicted concentration. Computer-generated TCI of propofol MCT/LCT during sedation is comparable with that of propofol LCT with respect to pharmacokinetics and pharmacodynamics. The formulation of MCT/LCT has a beneficial effect with respect to less pain on injection.
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Anaesth Intensive Care · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparison of oxygen cost of breathing between pressure-support ventilation and airway pressure release ventilation.
We compared the oxygen cost of breathing between pressure-support ventilation (PSV) and airway pressure release ventilation (APRV). This prospective, randomized, crossover study was conducted in a mixed ICU of a university hospital. Twenty clinically stable and spontaneously breathing patients after long-term mechanical ventilation were included. ⋯ There were no statistically significant differences with regard to respiratory rate, minute volume, and blood gas analysis. All patients tolerated both ventilatory modes without signs of discomfort. PSV and APRV produced similar results in terms of oxygen cost of breathing and other metabolic variables.
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Anaesth Intensive Care · Apr 2005
Randomized Controlled Trial Clinical TrialThe ProSeal laryngeal mask airway size selection in male and female patients in an Asian population.
The aim of this study was to investigate if size 5 compared with size 4 ProSeal laryngeal mask airway (PLMA) in Asian men and size 4 compared with size 3 ProSeal laryngeal mask airway (PLMA) in Asian women, would give a better glottic seal. We conducted a randomized crossover study involving 30 male and 30 female patients of Asian origin. Size 4 and size 5 PLMA were studied in men and size 3 and size 4 PLMA were studied in women. ⋯ The mean volume of air required to achieve an intracuff pressure of 60 cmH2O was less than the maximum recommended by the manufacturers. The size 5 PLMA in Asian men and size 4 PLMA in Asian women resulted in a more effective glottic seal. The use of size 5 PLMA in Asian men led to increased mucosal injury.
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Anaesth Intensive Care · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialRandomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions.
The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg x kg(-1) (n = 30), fentanyl 1 microg x kg(-1) (n = 30) or normal saline (n = 30), before induction of anaesthesia with propofol 2.5 mg x kg(-1). Insertion of the LMA was performed 60s after injection of propofol. ⋯ Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75-9.25); P = 0.024]. The incidence of prolonged apnoea (> 120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg x kg(-1) improves haemodynamics when compared to fentanyl 1 microg x kg(-1), with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).