Anaesthesia
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A questionnaire survey was conducted with 222 anaesthetists from 11 Scottish hospitals to measure their attitudes towards human and organisational factors that can have an impact on effective team performance and consequently on patient safety. A customised version of the Operating Room Management Attitude Questionnaire (ORMAQ) was used. ⋯ However, the results suggest that some anaesthetists do not fully appreciate the debilitating effects of stress and fatigue on performance. Their responses were comparable with (and slightly more favourable than) those reported in previous ORMAQ surveys of anaesthetists and surgeons in other countries.
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Twelve volunteers known to have airways that responded adversely to 2.0 MAC desflurane were recruited. Each volunteer inhaled three single breaths of each of 0.5, 1.0 and 2.0 MAC of sevoflurane, halothane, isoflurane, desflurane and balance air, with breaths of air between, whilst breathing nasally through a face mask attached to one of three filters that provided three different levels of humidification. ⋯ Increasing the concentration of anaesthetic also significantly increased the incidence of adverse airway events (p < 0.001). The filter used, and hence the level of humidification, did not affect the incidence of adverse airway events (p = 0.09), but repeated exposure caused a significant reduction in the incidence of adverse airway events (p < 0.001).
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomised double-blind comparative study of rocuronium and pancuronium in adult patients scheduled for elective 'fast-track' cardiac surgery involving hypothermic cardiopulmonary bypass.
The majority of cardiac anaesthetists in the UK use pancuronium for fast-track cardiac surgery. We compared the duration of action of pancuronium and rocuronium in patients undergoing fast-track hypothermic cardiopulmonary bypass and cardiac surgery. We determined whether patients would have had residual neuromuscular blockade at extubation. ⋯ The median difference in recovery times was 4 h 15 min (95% CI 2 h 30 min to 6 h 20 min; p = 0.0003 by Mann-Whitney test). None of the patients in the rocuronium group and seven of 10 patients in the pancuronium group had their extubations delayed because of residual neuromuscular blockade. Unless fast-track patients have neuromuscular function assessed before extubation, pancuronium should not be used.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of propofol and sevoflurane anaesthesia: effects on aortic blood flow velocity and middle cerebral artery blood flow velocity.
We compared systemic (aortic) blood flow and cerebral blood flow velocity in 30 patients randomly allocated to receive either propofol or sevoflurane anaesthesia. Cerebral blood flow velocity (CBFv) was measured in the middle cerebral artery using transcranial Doppler. Systemic blood flow velocity (SBFv) was measured in the aorta using transthoracic Doppler sonography at the level of the aortic valve. ⋯ The results demonstrated that propofol anaesthesia produced a significantly greater reduction in CsvI than did sevoflurane anaesthesia [propofol: 60 (19); sevoflurane: 83 (16), p = 0.009, t-test]. This suggests a direct reduction in CBFv independent of SBFv during propofol anaesthesia. The greater reduction of CBFv occurring during propofol anaesthesia may be due to lower cerebral metabolic demand compared with sevoflurane anaesthesia at comparable depths of anaesthesia.
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Acinetobacter baumannii is a significant problem in critically ill patients. It is widespread, can colonise patients quickly and causes virulent infections. However, its overall impact on morbidity and mortality in the critically ill remains unmeasured. ⋯ Of these, eight were colonised and three were infected. In the same period, 320 patients did not have A. baumannii and their mortality rate was 20% (n = 64). The mortality rate of patients with A. baumannii was significantly higher than that of patients without infection.