Anaesthesia
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Randomized Controlled Trial
The effect of intravenous lidocaine on QT changes during tracheal intubation.
Laryngoscopy and tracheal intubation may provoke changes of cardiac repolarisation. The aim of this study was to assess the effect of intravenous lidocaine on the ECG changes induced by laryngoscopy and tracheal intubation. Forty-three female patients were randomly allocated to receive lidocaine (1.5 mg.kg(-1)) or placebo immediately after induction of anaesthesia and changes in the ECG and arterial blood pressure were recorded. ⋯ In the placebo group, significant increases in QTcb, QTcf and QTcF values were observed after intubation compared to either control measurements or to comparative measurements in the lidocaine group. There were no significant differences in TDR either between or within the groups. Lidocaine diminishes prolongation of QTc, induced by tracheal intubation but there is no effect of intubation on TDR.
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Multicenter Study
Delirium is associated with early postoperative cognitive dysfunction.
The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects >or= 60 years old undergoing elective, non-cardiac surgery. Postoperatively, subjects were evaluated for delirium using the criteria of the Diagnostic and Statistical Manual. ⋯ Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1-2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6-2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive dysfunction remains unclear.
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The purpose of this study was to determine the optimal bolus dose of remifentanil required for the successful insertion of the laryngeal mask airway during propofol induction in children without a neuromuscular blocking agent. Twenty-six paediatric patients, aged 3-10 years, requiring anaesthesia for short ambulatory surgery were recruited. A predetermined bolus dose of remifentanil was injected over 30 s, followed by propofol 2.5 mg.kg(-1) over 10 s. ⋯ Laryngeal mask insertion was attempted 90 s after the end of remifentanil injection and the response of patients was classified as either 'movement' or 'no movement'. The bolus dose of remifentanil at which there was a 50% probability of successful laryngeal mask insertion (ED(50)) during induction with 2.5 mg.kg(-1) propofol was 0.56 (0.07) microg.kg(-1) in children without a neuromuscular blocking agent. From probit analysis, the ED(50) and ED(95) of remifentanil were 0.52 microg.kg(-1) (95% confidence limits, 0.42-0.62 microg.kg(-1)) and 0.71 microg.kg(-1) (95% confidence limits, 0.61-1.40 microg.kg(-1)), respectively.
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The ProSeal laryngeal mask airway (PLMA) has been used routinely for anaesthesia and for difficult airway management including airway rescue in non-fasted patients. Compared with the classic laryngeal mask airway the PLMA increases protection against gastric inflation and pulmonary aspiration, by separating the respiratory and gastro-intestinal tracts. The PLMA has potential advantages over use of the tracheal tube including smoother recovery, reduced pharyngolaryngeal morbidity and even reduced postoperative pain. ⋯ Anaesthesia was induced and maintained with remifentanil, target controlled propofol and rocuronium. A series of 102 cases were managed without complications and high rates of first time placement of the PLMA (inserted over a suction tube placed in the oesophagus). With careful patient selection the PLMA may offer an alternative airway for use by experienced anaesthetists in patients undergoing minor lower abdominal surgery.
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The i-gel, a novel supraglottic airway, has been proposed for use during cardiopulmonary resuscitation. We evaluated the performance of this device in manikins and anaesthetised patients when used by novices: medical students, non-anaesthetist physicians and allied health professionals all unfamiliar with the i-gel. Fifty i-gels were placed in manikins. ⋯ One case of regurgitation and partial aspiration occurred. Our results suggest the i-gel is rapidly inserted in both manikins and patients by novice users and compares favourably to other supraglottic airways available. Further work determining safety and efficacy during cardiopulmonary resuscitation is required.