Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised crossover trial comparing the i-gel supraglottic airway and classic laryngeal mask airway.
In a randomised cross-over study, we compared the performance of the single use i-gel supraglottic airway and reusable classic laryngeal mask airway (cLMA) in 50 healthy anaesthetised patients who were breathing spontaneously. Primary outcome was successful insertion at first attempt. Secondary outcomes included overall insertion success rate, ease of insertion, leak pressure and fibreoptic position. ⋯ The fibreoptic view through the device was significantly better with the i-gel than the cLMA, which was statistically significant (p = 0.03). We conclude that, with its current sizing recommendations, the i-gel is not an acceptable alternative to cLMA. However because of the significantly improved success rate after a larger sized i-gel was used, we recommend the manufacturer to review the sizing guidelines to improve the success rate.
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Anaesthetists have traditionally focused on technological and pharmacological advances when considering the provision of anaesthetic care. Anaesthetists are expected to be able to communicate effectively with peers, patients, their families and others in the medical community; however, few details are provided regarding how this might be achieved. ⋯ Understanding these processes could allow the development of a learnable framework for effective communication when the usual strategies are not working. This concept could also be used to facilitate communicating with surgeons and other colleagues, with potential benefits to patients.
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Review Meta Analysis
Meta-analysis on the effect of dopexamine on in-hospital mortality.
The objective of the study was to determine whether dopexamine alters in-hospital mortality. The following databases were searched, Embase (1974-July 2007), Medline (1950-July 2007), CINAHL, PubMed and Cochrane Clinical Register of Controlled Trials (CENTRAL). ⋯ Mortality was not significantly different with dopexamine treatment (relative risk 0.75, 95% confidence interval 0.48-1.18, p = 0.22). In conclusion, dopexamine does not improve in-hospital mortality in patients undergoing major abdominal surgery and in the critically ill.
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Review Meta Analysis
Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis.
Intrathecal morphine is often used for postoperative analgesia after surgery. We performed a meta-analysis to obtain more detailed information on the frequency of side-effects in patients receiving intrathecal morphine in combination with spinal anaesthesia compared with placebo treated patients. We clustered the analysis to patients receiving placebo, less than morphine 0.3 mg (M < 0.3), or equal to or more than morphine 0.3 mg (M > or = 0.3) and calculated the risk ratios of morphine vs placebo. ⋯ However, the higher dose of intrathecal morphine was associated with more episodes of respiratory depression (7/80) compared with the lower dose (2/247). Intrathecal morphine is associated with a mild increase in side-effects. With a dose < 0.3 mg we found there were no more episodes of respiratory depression than in placebo patients who received systemic opioid analgesia.