Anaesthesia
-
Review Meta Analysis
A peri-operative statin update for non-cardiac surgery. Part II: Statin therapy for vascular surgery and peri-operative statin trial design.
This is the second of two review articles evaluating peri-operative statin therapy. In surgical patients, the utility of peri-operative statin therapy is strongly suggested by retrospective studies, although it is probably overestimated, as important confounding factors have not been controlled for and hence the literature is considered to be currently inconclusive. ⋯ Peri-operative study design recommendations are suggested, so that future meta-analyses may be more informative. Recommendations are made regarding retrospective reporting of statin studies to minimise the bias inherent in a number of the current retrospective studies on this subject.
-
Target controlled infusions of propofol use a pharmacokinetic/pharmacodynamic model to calculate an effect site concentration of the drug. We assessed the cardiovascular stability of 10 healthy patients using non-invasive thoracic bioimpedance and their 'depth' of anaesthesia using the Bispectral index after they had been anaesthetised to a constant effect site concentration of propofol (6.5 min from starting). Each patient had no surgical stimulus and received no intravenous fluid during the study period. ⋯ We mathematically calculated when each measured parameter would reach a state of stability (i.e. with 95% certainty). Heart rate levelled off at 20 min, Bispectral index at 32 min, and cardiac index and mean arterial pressure at 47 min after achieving effect site stability, the final levels being, respectively, 21%, 47%, 14% and 28% lower than those at effect site stability. We conclude that cardiovascular parameters continue to change to a clinically significant degree after achieving a constant effect site concentration of propofol via target controlled infusions.
-
Multicenter Study
A national census of central neuraxial block in the UK: results of the snapshot phase of the Third National Audit Project of the Royal College of Anaesthetists.
The first stage of the Royal College of Anaesthetists Third National Audit Project to assess the incidence of major complications of central neuraxial block in the UK was a 2-week national census of block use. A reporting system was established in the 309 National Health Service hospitals believed to undertake surgical work and data were received from 304, a response rate of 98.7%. ⋯ The total number of procedures reported as being performed in the 2-week period was 27,533: extrapolation using a multiplier of 25 suggests that nearly 700,000 major blocks are performed annually (315,000 spinals, 287,000 cervical, thoracic or lumbar epidurals, 42,000 combined spinal-epidurals and 56,000 caudal epidurals). After the second stage of the project, which will record complications from the same hospitals over a 12-month period, these data will be used as denominators to calculate the incidences of complications.
-
Randomized Controlled Trial
The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation.
Traditional teaching of laryngoscopy is difficult due to the trainer and trainee lacking a shared view. The Karl Storz BERCI DCI Video Laryngoscope provides a video image for the trainer and a direct view identical to that of a standard laryngoscope for the trainee. Forty-nine novice subjects were randomly assigned to a control group (n = 24) taught using a standard Macintosh laryngoscope or a study group (n = 25) taught using the Video Laryngoscope. ⋯ Under simulated difficult airway conditions the study group performed better in terms of number of attempts (p = 0.02), number of repositioning manoeuvres required (p = 0.046) and teeth trauma (p = 0.034). The study group were more confident of the success of their tube placement (p = 0.035), found it easier than the control group (p = 0.042) and had improved knowledge of airway anatomy (p = 0.011). We conclude that video laryngoscopy confers benefits in the teaching of tracheal intubation.