Anaesthesia
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Randomized Controlled Trial
The effect of bolus administration of remifentanil on QTc interval during induction of sevoflurane anaesthesia.
Stimulation of the sympathetic nervous system associated with tracheal intubation causes corrected QT (QTc) interval prolongation. We postulated that the use of remifentanil during induction of anaesthesia might prevent this. ⋯ The QTc interval was significantly prolonged immediately following intubation in group S and group R0.5, but it remained stable in group R1.0, compared with the QTc interval just before laryngoscopy. It is concluded that the administration of remifentanil 1.0 microg x kg(-1) before intubation can prevent the prolongation of the QTc interval associated with tracheal intubation during induction of anaesthesia with sevoflurane.
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Multicenter Study
Monitoring during sedation given by non-anaesthetic doctors.
Conscious sedation is routinely performed by non-anaesthetic doctors. Although guidelines exist to help promote patient safety, it is not clear how stringently these are adhered to. We circulated a questionnaire to non-anaesthetic doctors in training to assess sedation practices. ⋯ Of respondents, 29% were Advanced Cardiac Life Support (ACLS) certified; and 22% reported an adverse event. Two respondents experienced adverse events that required the assistance of an anaesthetist. The practice of sedation is not without risk, and doctors involved in the practice should be aware of, and adhere to, appropriate guidelines.
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Randomized Controlled Trial Comparative Study
Laryngoscopy force in the sniffing position compared to the extension-extension position.
Laryngoscopy is sometimes easier with the patient's head and neck in the extension-extension position (head extension with the neck extended by the head section of the table bent down at 30 degrees) rather than the classical 'sniffing the morning air' position. We therefore tested the hypothesis that the axial force required for laryngoscopy is less in the extension-extension than the sniffing position. ⋯ The mean (SD) axial force required in the extension-extension position was lower than in the sniffing position (19.6 (7.8) N versus 23.6 (8.6) N, p = 0.04). In the setting of routine tracheal intubation, less force is required when the patient is in the extension-extension position than in the sniffing position.
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This prospective study on a medium-fidelity simulator (SimMan, Laerdal Medical Corporation, Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by 21 anaesthetists and the effect of training in this context. There were two scenarios investigated: 'cannot intubate, can ventilate' (CI) and 'cannot intubate, cannot ventilate' (CICV). Following initial evaluation, volunteers underwent training in the 'Difficult Airway Society' (DAS) algorithms and associated technical skills. ⋯ In both scenarios there was a reduced incidence of equipment misuse (p < 0.0005), which was sustained over time (p < 0.0001). We conclude that simulation-based training significantly improves performance for at least 6-8 weeks. Training should be repeated at intervals of 6 months or less.
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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a long and complex procedure with significant blood and fluid loss during debulking and important pathophysiological alterations during the HIPEC phase. We performed a retrospective analysis of 78 consecutive patients undergoing cytoreductive surgery with HIPEC at a university hospital. Our data demonstrate large intra-operative fluid turnover, with 51% of patients requiring a blood transfusion. ⋯ As a consequence of the raised body temperature, heart rate, end tidal carbon dioxide and arterial lactate levels increased with a slight metabolic acidosis. Peri-operative analysis of routine clotting parameters revealed disturbances of the coagulation status. For pain management, 72% of patients received supplementary thoracic epidural analgesia with consequential peri-operative opioid sparing and a reduced duration of postoperative ventilation.