Anaesthesia
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This study reviews the predictive value of maximum oxygen consumption (VO2max) and anaerobic threshold, obtained through cardiopulmonary exercise testing, in calculating peri-operative morbidity and mortality in non-cardiopulmonary thoraco-abdominal surgery. A literature review provided nine studies that investigated either one or both of these two variables across a wide range of surgical procedures. ⋯ We conclude that peak oxygen consumption and possibly anaerobic threshold are valid predictors of peri-operative morbidity and mortality in non-cardiopulmonary thoraco-abdominal surgery. These indicators could potentially provide a means of allocating increased care to high-risk patients.
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Randomized Controlled Trial
Monitor position and the accuracy and speed of ultrasound-guided nerve blocks.
Ultrasound is rapidly becoming an essential skill for all anaesthetists with an interest in regional anaesthesia. Using a single-blinded cross-over trial design, we assessed the accuracy and speed of simulated ultrasound-guided nerve blockade with the monitor either in direct line-of-sight or perpendicular to the line-of-sight. ⋯ Needle placement was significantly more accurate when anaesthetists had the monitor in front of them (29 acceptable) than to the side (22 acceptable). For anaesthetists with limited ultrasound experience, the accuracy, but not speed, of ultrasound guided regional anaesthesia can be improved by aligning the monitor in the line of sight of the operator.
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Randomized Controlled Trial
The impact of manual in-line stabilisation on ventilation and visualisation of the glottis with the LMA CTrach: a randomised crossover trial.
The LMA CTrach (CTrach) enables ventilation, glottis visualisation and tracheal intubation via a laryngeal mask conduit. The CTrach has been successfully used in patients with cervical spine pathology, but it is unclear if cervical spine immobilisation affects its ease of use. In this randomised crossover trial, the CTrach was used once with and once without manual in-line stabilisation of the cervical spine in every patient. ⋯ With manual in-line stabilisation, the time to achieving a glottic views was 42 [30-63] s compared with 39 [25-53] s without stabilisation (p = 0.019). There was no difference in the success rates of achieving ventilation and glottic views. These results suggest that manual in-line stabilisation does not affect use of the CTrach.
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Reported are three cases of successful tracheal intubation using the McGrath Video Laryngoscope in awake patients. All three patients had predicted difficult direct laryngoscopy and signs of upper airway obstruction.
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Maternal heart rate variability of 62 parturients were compared based on their choice of using (epidural group, 44 women) or not using (control, 18 women) epidural analgesia. Baseline heart rate variability and visual analogue scores were recorded when the cervix of the parturient dilated to 2-4 cm, and paired data were collected 1 h later. ⋯ Almost all heart rate variability measures were unchanged 1 h later in both groups. We concluded that parturients who chose epidural analgesia had greater heart rate variability, and that percentage of absolute difference in successive RR intervals exceeding 20 ms could reflect their likelihood of requesting epidural analgesia at the beginning of labour.