Anaesthesia
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Randomized Controlled Trial
Effects of different doses of remifentanil on the end-tidal concentration of sevoflurane required for tracheal intubation in children.
We investigated the effects of different doses of remifentanil on the end-tidal concentration of sevoflurane required for tracheal intubation in children without the use of neuromuscular blocking drugs. One hundred and thirty paediatric patients, aged 3-8 years, were randomly allocated to receive no remifentanil (group control) or remifentanil 0.1 microg kg(-1) min(-1) (group remi(0.1)), 0.2 microg kg(-1) min(-1) (group remi(0.2)), 0.3 microg kg(-1) min(-1) (group remi(0.3)). All patients were anaesthetised using 5% sevoflurane. ⋯ Successful intubation was defined as excellent or good intubating conditions. The end-tidal concentration (SD) of sevoflurane for successful tracheal intubation in 50% of children (ED(50)) were 5.16 (0.22)% in control, 3.27 (0.18)%, 1.81 (0.20)% and 1.01 (0.11)%, in remi(0.1), remi(0.2), and remi(0.3) groups, respectively. Using probit analysis, the 95% effective dose (ED(95)) of sevoflurane were 5.60% (95% CI 5.35-7.66), 3.77% (95% CI 3.45-7.74), 2.18% (95% CI 1.96-3.86), 1.19% (95% CI 1.06-1.82) in control, remi(0.1), remi(0.2), and remi(0.3) groups, respectively.
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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.