Anaesthesia
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Comparative Study
Monitoring of intra-operative nociception: skin conductance and surgical stress index versus stress hormone plasma levels.
'Surgical Stress Index' and the 'Number of Fluctuations in Skin Conductance.s⁻¹, use different methods to analyse sympathetic tone and so provide an estimate of peri-operative analgesia. The aim of our study was to investigate the relationship between these methods and stress hormone plasma levels. ⋯ Surgical Stress Index, heart rate and blood pressure, but not the 'Number of Fluctuations in Skin Conductance.s⁻¹ changed in response to changes in depth of analgesia by showing significant differences between before and after a bolus of fentanyl. However, the overall predictive ability of both methods was poor.
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We compared the minimum local analgesia concentration of ropivacaine for intra-operative caudal analgesia in pre-school and school age children. Fifty-one boys, undergoing hypospadius repair surgery, were stratified into pre-school or school age groups. ⋯ Under general anaesthesia with 0.7 minimum alveolar concentration of sevoflurane, the minimum local analgesia concentration of ropivacaine for intra-operative caudal block was 34% greater in school age than in pre-school age boys (0.143% (95% CI 0.132-0.157%) vs 0.107% (95% CI 0.089-0.122%), respectively; p < 0.001). This study indicates that a higher concentration of ropivacaine is needed for school age than pre-school age children to provide intra-operative caudal analgesia when combined with general anaesthesia.
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Induced hypothermia following cardiac arrest is a common treatment in the critical care unit. Topical cooling measures are easy to initiate and widely utilised. We report a case of brachial plexopathy occurring in association with topical cooling measures and discuss the diagnosis, management and avoidance of such complications.
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We compared a small and transportable Capnometer (EMMA™) with a reference capnometer, the Siesta i TS Anaesthesia. During air-breathing through a facemask, both the EMMA (nine modules) and reference capnometer sampled expired gas simultaneously. A wide range of end-tidal carbon dioxide values were obtained during inhalation of carbon dioxide and voluntary hyperventilation. ⋯ The 95% CI of the medians of the differences were -0.4 to -0.2. We conclude that the EMMA can slightly under-read the end-tidal carbon dioxide but is generally comparable with a free-standing monitor. The precision of the EMMAs was similar whether new batteries or batteries with reduced voltage were used.
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Fibreoptic intubation is the gold standard for patients with predicted difficult intubation. The Ambu(®) aScope™ is a single-use device for fibreoptic tracheal intubation. We assessed its performance in 10 patients with predicted difficult tracheal intubation. ⋯ However, the limited time of use did not permit intubation in one patient who required three attempts with different size tracheal tubes. The limited image resolution that can be expected of a single-use fibreoptic system and the absence of a suction channel are other potential limitations. On the other hand, being single-use this device has the advantage of avoiding the risk of infectious disease transmission and is always ready to use.