Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised controlled trial comparing rocuronium priming, magnesium pre-treatment and a combination of the two methods.
We investigated whether magnesium sulphate combined with rocuronium priming shortens the onset of neuromuscular blockade, compared with these methods used alone. Ninety-two patients scheduled for general anaesthesia were randomly allocated to one of four groups: controls were given 0.6 mg.kg(-1) rocuronium; patients in the prime group were given 0.06 mg.kg(-1) rocuronium three minutes before a further dose of 0.54 mg.kg(-1) rocuronium; patients in the magnesium group were given an infusion of 50 mg.kg(-1) magnesium sulphate before rocuronium and patients in the magnesium and prime group were given both the magnesium sulphate and the priming dose of rocuronium. Tracheal intubation was attempted 40 s after the rocuronium injection. ⋯ No statistical difference was found for the duration of blockade. As for adverse events, a burning or heat sensation was reported in eight (35%) and six (26%) patients in the magnesium and magnesium and prime groups, respectively. The combination of magnesium sulphate and rocuronium priming accelerated the onset or neuromuscular blockade and improved rapid-sequence intubating conditions, compared with either magnesium sulphate or priming used alone.
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Randomized Controlled Trial Comparative Study
A randomised trial comparing the CEL-100 videolaryngoscope(TM) with the Macintosh laryngoscope blade for insertion of double-lumen tubes.
We performed a randomised trial comparing the CEL-100 videolaryngoscope(TM) with the Macintosh laryngoscope blade in 170 patients undergoing double-lumen tube placement for thoracic surgery. Compared with the Macintosh laryngoscope blade, use of the CEL-100 resulted in significantly more patients with a Cormack and Lehane Grade-1 laryngeal view (90.4% vs 61.0%, p < 0.001), a higher rate of successful intubation on the first attempt (92.8% vs 79.3%, p = 0.012), a lower median (IQR [range]) intubation difficulty score (0 (0-0 [0-60]) vs 15 (0-30 [0-80]), p < 0.001), a higher incidence of correct positioning of the tube (90.3% vs 79.2%, p = 0.041) and significantly fewer patients requiring external laryngeal pressure (19.3% vs 32.9%, p = 0.046). Median (IQR [range]) time to successful intubation was 45 (38-55 [22-132]) s with the CEL-100 compared with 51 (40-61 [30-160] s using the Macintosh laryngoscope blade. We conclude that the CEL-100 videolaryngoscope is superior to the Macintosh laryngoscope blade for double-lumen tube insertion.
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Randomized Controlled Trial
The educational value of using cumulative sum charts.
Various workplace-based assessment tools are available, but none have been shown to improve performance in procedural skills. This study aimed to assess the impact of using one such tool, cumulative sum charts, on procedural skill ability. A single-blind randomised controlled trial was conducted on 82 final year medical students. ⋯ Students in the intervention group obtained median (IQR [range]) scores of 68.2 (60.5-74.3 [42.7-81.1]) vs 62.2 (52.2-68.8 [40.7-80.5]) for the control group (p = 0.013). The effect size was moderate (Cohen's d = 0.608). This study therefore provides support for the hypothesis that use of cumulative sum charts improves performance when learning procedural skills.
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Randomized Controlled Trial Comparative Study
Comparison of the antitussive effect of remifentanil during recovery from propofol and sevoflurane anaesthesia.
This prospective randomised study compared the antitussive effect of remifentanil during recovery from either propofol or sevoflurane anaesthesia. Seventy-four female patients undergoing thyroidectomy were anaesthetised with either propofol and remifentanil or sevoflurane and remifentanil. ⋯ Time to awakening and time to extubation were significantly shorter in the propofol group (4.7 min, 6.1 min min, respectively) compared with the sevoflurane group (7.9 min and 8.9 min respectively) (p < 0.001 and p = 0.002, respectively). An effect-site concentration of 2 ng.ml(-1) of remifentanil was associated with smooth emergence from both propofol and sevoflurane anaesthesia.
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Randomized Controlled Trial
Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position.
The prone position can reduce cardiac output by up to 25% due to reduced preload. We hypothesised that preload optimisation targeted to stroke volume variation before turning prone might alleviate this. ⋯ In 45 patients, cardiac output declined only in the group whose supine stroke volume variation was high (mean (SD) 5.1 (2.0) to 3.9 (1.9) l.min(-1) ; p < 0.001), but not in patients in whom it was low, or in those in whom stroke volume variation was high, but who received volume preload (p = 0.525 and 0.941, respectively). We conclude that targeted preload optimisation using a supine stroke volume variation value < 14% is effective in preventing falls in cardiac output induced by the prone position.