Anaesthesia
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Randomized Controlled Trial
Ultrasound-guided interscalene blocks: understanding where to inject the local anaesthetic.
Although ultrasound-guided regional anaesthesia has gained in popularity, few data exist describing the optimal location(s) to inject local anaesthetic. Our objective was to compare, for interscalene blocks, the effectiveness of an injection between the middle scalene muscle and brachial plexus sheath (peri-plexus) with an injection within the brachial plexus sheath (intra-plexus). We enrolled 170 patients undergoing shoulder surgery with general anaesthesia and interscalene block in this randomised, controlled trial. ⋯ Block quality was also measured and defined by an evaluation of onset time, sensory and motor loss and duration. There was no difference between the two groups in block onset times or block quality. After adjusting for sex, age and volume injected, intra-plexus blocks lasted a mean of 2.6 h (16%) longer (95% CI 0.25-5.01, p=0.03) than peri-plexus blocks.
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Randomized Controlled Trial Comparative Study
Comparison of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery.
The aim of our study was to compare leakage pressure, ease and time of insertion of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery. In this prospective, randomised crossover trial, we included patients with a body mass index (BMI) >25 and <35 kg.m(-2) , and , age >18 years, undergoing elective surgery in the supine position with an expected duration of surgery <2 h. Leakage pressures, insertion difficulty, time and number of insertion attempts were evaluated. ⋯ Mean (SD) leakage pressures were 23.7 (9.2) cmH₂O (i-gel) and 17.4 (7.0) cmH₂O (LMA-Unique) (p<0.01). Subgroup analyses showed leakage pressures of 22.2 (9.4) cmH₂O (i-gel) and 17.5 (7.5) cmH₂O (LMA-Unique) (p=0.013) in the mild subgroup, and 25.7 (8.6) cmH₂O (i-gel) and 17.0 (6.2) cmH₂O (LMA-Unique) (p<0.01), in the moderate subgroup. Insertion of the i-gel was associated with significantly higher leakage pressures compared with the LMA-Unique in mildly and moderately obese patients.
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Five recent cohort studies have shown a frequency of awareness in paediatric anaesthesia of between 0.2% and 1.2%, but they were not individually large enough to identify risk factors. This study pooled raw data from these five studies to identify factors associated with awareness in children. The outcome of awareness was taken as the cases judged to be most likely awareness cases in each study. ⋯ A combined sample of 4486 anaesthetics revealed 33 cases of awareness. Unadjusted analysis demonstrated weak evidence that nitrous oxide used as an anaesthetic maintenance adjunct was associated with awareness (OR 2.04 (95% CI 0.97-4.33), p=0.06), and some evidence that use of a tracheal tube was associated with awareness (OR 2.78 (95% CI 1.11-6.94), p=0.03). Multivariable regression analysis revealed that nitrous oxide maintenance and use of a tracheal tube were independently associated with awareness (nitrous oxide, OR 2.4 (95% CI 1.08-5.32), p=0.03; tracheal tube, OR 3.0 (95% CI 1.20-7.56), p=0.02).
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Randomized Controlled Trial Comparative Study
The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery.
We investigated the influence of either propofol or desflurane on the incidence of postoperative cognitive dysfunction in a randomised trial of 180 patients undergoing coronary artery bypass surgery. The primary outcome was incidence of postoperative cognitive dysfunction at 3 months, defined as ≥1 SD deterioration in two or more of 12 neurocognitive tests. ⋯ There was no difference in delirium (7/89 (7.9%) vs 12/91 (13.2%), respectively, length of hospital stay (median (IQR [range]) 7 (6-9 [4-15]) vs 6 (5-7 [5-16) days, respectively or other morbidities. Desflurane was associated with reduced early cognitive dysfunction.