Anaesthesia
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Comparative Study
Predicting adverse outcomes of cardiac surgery with the application of artificial neural networks.
Risk-stratification models based on pre-operative patient and disease characteristics are useful for providing individual patients with an insight into the potential risk of complications and mortality, for aiding the clinical decision for surgery vs non-surgical therapy, and for comparing the quality of care between different surgeons or hospitals. Our study aimed to apply artificial neural networks (ANN) models to predict mortality and morbidity after cardiac surgery, and also to compare the efficacy of this model to that of the logistic regression model and Parsonnet score. The accuracy of the ANN, logistic regression and Parsonnet score in predicting mortality was 83.8%, 87.9% and 78.4%. ⋯ The area under the receiver operating characteristic curves (AUC) of the ANN, logistic regression and Parsonnet score in predicting in-hospital mortality were 0.873, 0.852 and 0.829. The AUCs of the ANN, logistic regression and Parsonnet score in predicting major morbidity were 0.852, 0.789 and 0.727. The results showed the ANN models have the best discriminating power in predicting in-hospital mortality and morbidity among these models.
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Randomized Controlled Trial Comparative Study
Comparison of fibreoptic-guided intubation through ILMA versus intubation through LMA-CTrach.
We compared the time taken to intubate the trachea of a manikin by fibreoptic-guided intubation through an intubating laryngeal mask airway (ILMA-FOS) with intubation through a laryngeal mask airway CTrach (LMA-CTrach). Forty-two anaesthetists participated in this randomised crossover study. ⋯ Thirty (71%) anaesthetists preferred LMA-CTrach as compared with ILMA-FOS (p = 0.008). We conclude that LMA-CTrach is a suitable alternative to fibreoptic-guided intubation through ILMA for the management of unanticipated failed intubation.
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Review Meta Analysis
A quantitative review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids.
This quantitative review summarises studies of rigid fibreoptic laryngoscopy systems. In 6622 'normal' patients only the Bonfils and CTrach had homogenous data and first time intubation success rates above 90%. In 1110 patients predicted or known to be difficult to intubate only the Bonfils, CTrach and Glidescope had homogenous data and first-time success rates above 90%. ⋯ The currently available data do not provide strong evidence that these devices should supersede standard direct laryngoscopy for routine or difficult intubation. Further research needs to be of high quality, studying relevant patients to create such evidence. Multicentre collaborations are likely to be needed studying known difficult patients or creating databases reporting the success/failure rate of these devices.
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Randomized Controlled Trial
The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction.
The usefulness of mannitol in the priming fluid for cardiopulmonary bypass is uncertain in patients with normal renal function, and has not been studied in patients with established renal dysfunction. We studied 50 patients with serum creatinine between 130 and 250 micromol.l(-1) having cardiac surgery. ⋯ There were no differences between the groups in plasma creatinine or change in creatinine from baseline, urine output, or fluid balance over the first three postoperative days. We conclude that mannitol has no effect on routine measures of renal function during cardiac surgery in patients with established renal dysfunction.