Anaesthesia
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Acute pulmonary hypertension with life-threatening right heart failure may complicate the postoperative course following cardiothoracic surgery. Both inhaled nitric oxide and inhaled iloprost, a stable analogue of prostacyclin, have been used frequently for this purpose in acute pulmonary hypertension of various origins. We present a case of a patient with acute pulmonary hypertension and severely impaired gas exchange following pulmonary thrombo-endarterectomy. ⋯ Combined inhaled nitric oxide and inhaled iloprost, however, showed additive effects. Hence, the combination of both drugs may be reasonable in cases where the standard therapy fails. The effect has been demonstrated by means of continuous blood gas monitoring.
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As the incidence of diabetes mellitus continues to increase in the United Kingdom, more diabetic patients will present for both elective and emergency surgery. Whilst the underlying pathophysiology of type 1 and type 2 diabetes differs, there is much good evidence that controlling the blood glucose to < or = [corrected] 10 mmol.l(-1) in the peri-operative period for both types of diabetic patients improves outcome. This should be achieved with a glucose-insulin-potassium regimen in all type 1 diabetics and in type 2 diabetics undergoing moderate or major surgical procedures. After surgery, a decrease in the catabolic hormone response resulting from good analgesia and the avoidance of nausea and vomiting should allow early re-establishment of normal glycaemic control.
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Randomized Controlled Trial
The efficacy of pharyngeal packing during routine nasal surgery--a prospective randomised controlled study.
The efficacy of pharyngeal packing in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing nasal surgery was evaluated in a prospective randomised controlled study. The effect of the presence of the pharyngeal pack on the incidence of postoperative sore throat was also assessed. ⋯ The absence of a pharyngeal pack was not associated with an increase in postoperative aspiration or vomiting. We conclude that the routine placement of pharyngeal packs during uncomplicated nasal surgery has no effect on the incidence of PONV and will increase the incidence of postoperative sore throat.
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Randomized Controlled Trial
The use of impedance respirometry to confirm tracheal intubation in children.
Accidental oesophageal intubation can occur in children and is a cause of morbidity and mortality. This study investigated the use of impedance respirometry to determine tracheal tube position in children aged 1-10 years. Eighty children were recruited and, after induction of anaesthesia, two identical tracheal tubes were inserted: one into the trachea and one into the oesophagus. ⋯ The sensitivity of the test was 0.975 and the specificity 0.925. The median number of breaths needed to identify the position of the tubes was 2.0 for both groups. This is not a perfect technique in the population studied but when used with other methods of tracheal tube position identification, its use could decrease the time taken to identify incorrect placement.
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Randomized Controlled Trial
The effect of additional teaching on medical students' drug administration skills in a simulated emergency scenario.
Medical students have difficulty calculating drug doses correctly, but better teaching improves their performance in written tests. We conducted a blinded, randomised, controlled trial to assess the benefit of online teaching on students' ability to administer drugs in a simulated critical incident scenario, during which they were scored on their ability to administer drugs in solution presented as a ratio (adrenaline) or percentage (lidocaine). ⋯ Drug administration error is a very major problem and few interventions are known to be effective. We show that focusing on better teaching at medical school may benefit patient safety.