Anaesthesia
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The minimally invasive CardioQP oesophageal Doppler probe estimates cardiac output by measuring blood flow velocity in the descending aorta. Individual variables to enter are patient's age, weight and height. We measured cardiac output simultaneously with CardioQP and pulmonary artery catheter thermodilution techniques during heart catheterisation in 40 paediatric patients with congenital heart defects. ⋯ Bias and precision were 0.66 l.min(-1) and 1.79 l.min(-1) (95% limits of agreement: -1.13 to +2.45 l.min(-1)). Based on our preliminary experience, cardiac output values measured by CardioQP in children do not reliably represent cardiac output values compared with the thermodilution technique. We suggest measurement of individual aortic diameter to improve performance of the CardioQP.
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Randomized Controlled Trial
Significance of the injection timing of ephedrine to reduce the onset time of rocuronium.
We postulated that the onset time of rocuronium can be accelerated effectively if it is administered at the time when the effect of ephedrine on cardiac output has reached its maximum. Seventy-five male, anaesthetised, patients were randomly allocated to three groups. Ephedrine 70 microg.kg(-1) was administered at 4 min (Early) or 30 s (Late) before administering rocuronium. ⋯ The onset time of rocuronium in the Early group was significantly shorter than in the Control group, but there was no difference in the onset time between the Late and Control groups. There were no significant differences in the intubating conditions of the three groups. Ephedrine 70 microg.kg(-1) can reduce the onset time of rocuronium effectively if rocuronium is administered at 4 min following the ephedrine injection, when the effect of ephedrine on cardiac output is expected to reach its maximum.
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Anaesthesia for Caesarean section was audited over a 5 year period: 5080 cases were performed using spinal 63%, epidural top-up 26%, combined spinal-epidural 5% and primary general anaesthesia 5%. The rate of general anaesthesia conversion of regional anaesthesia was 0.8% for elective and 4.9% for emergency Caesarean section compared to Royal College of Anaesthetists targets of 1% and 3%. The rate of conversion of regional to general anaesthesia in category 1 Caesarean section was 20%. ⋯ For spinal anaesthesia, use of a spinal opioid was associated with less pre-operative failure. For epidural top-up anaesthesia, lower epidural top-up volume was associated with less pre-operative failure, and use of adrenaline was associated with both less pre-operative and intra-operative failure. The rate of serious adverse incidents was 1 : 126 with general anaesthesia and 1 : 501 with regional anaesthesia.
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The use of ultrasound guidance for central venous access is widespread and was recommended as the technique of choice by The National Institute of Clinical Excellence in the UK in 2002. However, complications have been reported using this technique. ⋯ We then discuss the development of three- and four-dimensional ultrasound and describe our experiences using this imaging modality in simulated and actual needle-guidance. We discuss the potential advantages for clinicians utilising this newer form of ultrasound imaging for central venous access.