Anaesthesia
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Angelman syndrome is a complex genetic condition involving abnormalities of chromosome 15 in the majority of cases. These defects involve a gene encoding an ubiquitin protein ligase and may be associated with abnormal gamma-aminobutyric acid (GABA)(A) receptor subunits. ⋯ A case of an adult with Angelman syndrome undergoing dental work under general anaesthesia is presented. Induction and maintenance of anaesthesia was unremarkable but emergence was complicated by generalised muscular hypertonia and temporary respiratory embarrassment which resolved spontaneously.
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Randomized Controlled Trial Comparative Study
A prospective, randomised, cross-over trial comparing the EndoFlex and standard tracheal tubes in patients with predicted easy intubation.
We aimed to determine if using the EndoFlex tracheal tube on the first intubation attempt provided improved placement times and intubation success compared with a standard-type tracheal tube in 50 patients undergoing gynaecological surgery in a prospective, randomised, cross-over trial. We found that using the EndoFlex resulted in shorter intubation times (mean (SD) 14.8 (9.7) vs 30.1 (30.5) s), easier intubation (VAS, median (range) 10 (0-70) vs 20 (0-100)), and an increased rate of successful insertion at the first attempt; all p < 0.001. ⋯ Furthermore, patients with a grade 2 (19/50) or 3 (6/50) laryngoscopic view had shorter intubation times, easier intubation and reduced insertion attempts with the EndoFlex. The EndoFlex is a satisfactory alternative to a standard-type tracheal tube, even with an anterior larynx.
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Randomized Controlled Trial
Assessing the clinical or pharmaco-economical benefit of target controlled desflurane delivery in surgical patients using the Zeus anaesthesia machine.
The Zeus anaesthesia machine includes an auto-control mode which allows targeting of end-tidal volatile and inspired oxygen concentrations. We assessed the clinical benefits and economic impact of this target-controlled anaesthesia compared with conventional manually controlled anaesthesia. Eighty patients were randomly assigned to receive desflurane either with a fresh gas flow set by the anaesthetist or in auto-control mode. ⋯ Oxygen consumption was more than halved by the use of auto-control mode, and mean (SD) desflurane consumption during surgery was 0.07 (0.04) vs 0.2 (0.07) ml.min(-1) in auto-control and manual control respectively (p < 0.0001). The number of drug delivery adjustments per hour was significantly lower in auto-control mode (mean (SD) 7 (2) vs 15 (12); p < 0.0001). Thus, the auto-control mode provided similar haemodynamic stability and bispectral control as did conventional manually controlled anaesthesia, but led to a reduction in gas and vapour consumption with a more clinically acceptable workload.
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Multicenter Study
The influence of various graphical and numeric trend display formats on the detection of simulated changes.
Integration of a large amount of information is important in anaesthesia but there is little research to guide the development of data displays. Anaesthetists from two hospitals participated in five related screen based simulation studies comparing various formats for display of historical or 'trend' data. Participants were asked to indicate when they first noticed a change in each displayed variable. ⋯ If the same number of data points were included, there was no difference between graphical and numerical displays of historical data. There was no difference in accuracy between graphical or numerical displays. These results suggest that the way trend data is presented can influence the speed of detection of changes.