Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Comparison of visual and electromyographic assessments with train-of-four stimulation of the ulnar nerve: a prospective cohort study.
The use of a peripheral nerve stimulator to assess the level of neuromuscular blockade tasks the anesthesia clinician with subjectively assessing the response to neurostimulation. In contrast, objective neuromuscular monitors provide quantitative information. The purpose of this study was to compare subjective evaluations from a peripheral nerve stimulator with objective measurements of neurostimulation responses from a quantitative monitor. ⋯ Subjective observations of a "twitch" do not consistently correspond to objective measurements of neuromuscular blockade with electromyography. Subjective evaluation overestimates the response to neurostimulation and may be unreliable for determining the depth of block or confirming adequate recovery.
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Randomized Controlled Trial
A randomized controlled trial comparing three supraglottic airway devices used as a conduit to facilitate tracheal intubation with flexible bronchoscopy.
Once difficult ventilation and intubation are declared, guidelines suggest the use of a supraglottic airway (SGA) as a rescue device to ventilate and, if oxygenation is restored, subsequently as an intubation conduit. Nevertheless, few trials have formally studied recent SGA devices in patients. Our objective was to compare the efficacy of three second-generation SGA devices as conduits for bronchoscopy-guided endotracheal intubation. ⋯ ClinicalTrials.gov (NCT02975466); registered on 29 November 2016.
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Randomized Controlled Trial
Applied forces with direct versus indirect laryngoscopy in neonatal intubation: a randomized crossover mannequin study.
In adult mannequins, videolaryngoscopy improves glottic visualization with lower force applied to upper airway tissues and reduced task workload compared with direct laryngoscopy. This trial compared oropharyngeal applied forces and subjective workload during direct vs indirect (video) laryngoscopy in a neonatal mannequin. ⋯ ClinicalTrials.gov (NCT05197868); registered 20 January 2022.
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Observational Study
A prospective observational study of the efficacy of ketamine for rescue analgesia in the postanesthesia recovery unit.
Early severe postoperative pain is frequently resistant to management with opioid analgesia alone. Perioperative low-dose ketamine as an analgesia adjunct has been studied extensively. Its efficacy as a rescue analgesic in the postanesthesia care unit (PACU) has not been determined. The objective of this study was to evaluate the analgesic efficacy of low-dose bolus ketamine for opioid-resistant pain in the PACU by measuring its effect on numerical rating scale (NRS) pain scores and opioid requirement. ⋯ Administration of low-dose bolus ketamine in the PACU for severe opioid-resistant pain was associated with a significant improvement in analgesia in this observational study.
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Comment Letter Case Reports
Accidental infusion of tranexamic acid via a thoracic epidural catheter.