Anaesthesia
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Randomized Controlled Trial Comparative Study
The addition of dexamethasone to dolasetron or haloperidol for treatment of established postoperative nausea and vomiting.
It is not known whether dexamethasone increases the effectiveness of anti-emetics when given to treat postoperative nausea and vomiting (PONV). In a randomised study, 242 patients who were experiencing PONV received dolasetron and placebo, haloperidol and placebo, dolasetron and dexamethasone, or haloperidol and dexamethasone. ⋯ PONV recurred significantly less frequently in patients treated with additional dexamethasone (33%) than in patients treated without additional dexamethasone (51%). The combination of dexamethasone with dolasetron or dexamethasone with haloperidol is superior to dolasetron or haloperidol alone for the treatment of PONV.
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Randomized Controlled Trial Comparative Study
A comparison of the Truview blade with the Macintosh blade in adult patients.
The Truview blade facilitates a view of the vocal cords by indirect laryngoscopy. We prospectively compared the view obtained at laryngoscopy and intubating conditions of Truview (Group 1) or Macintosh (Group 2) blades in 170 patients who were scheduled to undergo general anaesthesia. We studied pre-operative airway evaluation, laryngoscopic view, duration of intubation, maximal force applied during intubation, anaesthetist's estimation of intubation effort on a 1-3 scale, bleeding, teeth and soft tissue damage, and postoperative stridor and hoarseness. ⋯ No significant difference was found in the anaesthetist's estimation of intubation effort, tooth damage or postoperative stridor and hoarseness. Significantly fewer patients suffered bleeding and soft tissue damage following intubation with the Truview than with the Macintosh blade. The Truview blade is a useful option for tracheal intubation in patients with normal and anticipated difficult airways.
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Comparative Study
An evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery.
The bias, precision and tracking ability of five different pulse contour methods were evaluated by simultaneous comparison of cardiac output values from the conventional thermodilution technique (COtd). The five different pulse contour methods included in this study were: Wesseling's method (cZ); the Modelflow method; the LiDCO system; the PiCCO system and a recently developed Hemac method. We studied 24 cardiac surgery patients undergoing uncomplicated coronary artery bypass grafting. ⋯ Bland-Altman analysis showed the following bias and limits of agreement: cZ, 0.23 and - 0.80 to 1.26 l.min(-1); Modelflow, 0.00 and - 0.74 to 0.74 l.min(-1); LiDCO, - 0.17 and - 1.55 to 1.20 l.min(-1); PiCCO, 0.14 and - 1.60 to 1.89 l.min(-1); and Hemac, 0.06 and - 0.81 to 0.93 l.min(-1). Changes in cardiac output larger than 0.5 l.min(-1) (10%) were correctly followed by the Modelflow and the Hemac method in 96% of cases. In this group of subjects, without congestive heart failure, with normal heart rhythm and reasonable peripheral circulation, the best results in absolute values as well as in tracking changes in cardiac output were measured using the Modelflow and Hemac pulse contour methods, based on non-linear three-element Windkessel models.
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Case Reports
The use of propofol and remifentanil for the anaesthetic management of a super-obese patient.
Morbid obesity is defined as body mass index (BMI) > 35 kg.m(-2), and super-obesity as BMI > 55 kg.m(-2). We report the case of a 290-kg super-obese patient scheduled for open bariatric surgery. A propofol-remifentanil TCI (target controlled infusion) was chosen as the anaesthetic technique both for sedation during awake fibreoptic nasotracheal intubation and for maintenance of anaesthesia during surgery. ⋯ A significant difference between measured and predicted plasma propofol concentrations was found. After performing a computer simulation, we found that predictive performance would have improved significantly if we had used an unadjusted pharmacokinetic set. However, in conclusion (despite the differences between measured and predicted plasma propofol concentrations), the use of a propofol-remifentanil TCI technique both for sedation during awake fibreoptic intubation and for Bispectral Index-guided propofol-remifentanil anaesthesia resulted in a rapid and effective induction, and operative stability and a rapid emergence, allowing rapid extubation in the operating room and an uneventful recovery.
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Multicenter Study
Recovery from neuromuscular blockade: a survey of practice.
At present in the UK there is no consensus regarding the parameters anaesthetists use to indicate adequacy of reversal from neuromuscular blockade. In an attempt to determine current practice, we carried out a survey covering 12 anaesthetic departments throughout the UK. Individuals were asked to give details regarding their usage of available monitors or, alternatively, to list those clinical parameters which they felt offered the best guidance as to the adequacy of recovery from neuromuscular blockade. ⋯ Insufficient reliance is placed upon the use of quantitative monitors. There is a lack of clarity in national anaesthetic guidelines with respect to monitoring of neuromuscular function. Current standards need to be re-assessed in the light of recent improvements in nerve stimulators.