Anaesthesia
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Multicenter Study
Review of patient safety incidents reported from critical care units in North-West England in 2009 and 2010.
We categorised and established the rates of patient safety incidents reported during 2009 and 2010 from critical care units in 12 hospital trusts in North-West England. We identified a total of 4219 incidents reported during 127, 467 calendar days of critical care with a median (IQR [range]) of 31 (26-45 [20-57]) incidents per 1000 days per trust. A median (IQR [range]) of 10 (7-13 [3.5-27]) incidents per 1000 days were associated with harm. ⋯ Five incidents described the use of inappropriate arterial flush solutions. It is possible to compare rates of incident reporting in different trusts over time to determine if different methods of care are associated with different reporting rates. The wide range of reported pressure sore rates suggests that their incidence could be reduced.
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Randomized Controlled Trial Comparative Study
A comparison of Rapydan® patch and Ametop® gel for venous cannulation.
Ametop(®) gel (4% tetracaine) is used to provide topical anaesthesia for venous cannulation. Rapydan(®) patch (7% lidocaine and 7% tetracaine) has been developed to provide topical anaesthesia by a different mechanism, that of heat assisted delivery. We compared the topical anaesthetic effect of these agents for venous cannulation. ⋯ Median(IQR[range]) pain scores were not different between groups with 11 (5-20 [0-72]) for Rapydan and 10 (5-24 [0-95]) for Ametop (p = 0.63). Adequate topical anaesthesia was achieved in over 90% of patients in both groups. Rapydan produces topical anaesthesia comparable with Ametop for venous cannulation.
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Randomized Controlled Trial Comparative Study
A randomised comparison of two intranasal dexmedetomidine doses for premedication in children.
We compared sedation levels in children following administration of intranasal dexmedetomidine. One hundred and sixteen children aged between 1 and 8 years were enrolled in this prospective, randomised trial. Children were assigned to receive either intranasal dexmedetomidine 1 μg.kg(-1) (Group 1) or 2 μg.kg(-1) (Group 2). ⋯ Both doses produced a similar level of satisfactory sedation in children aged 1-4 years, whereas 2 μg.kg(-1) resulted in a higher proportion of satisfactory sedation in children aged 5-8 years. There were no adverse haemodynamic effects. We conclude that intranasal dexmedetomidine in a premedication dose of 2 μg.kg(-1) resulted in excellent sedation in children.
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Randomized Controlled Trial Comparative Study
Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope® videolaryngoscopy.
Laryngoscopy can induce stress responses that may be harmful in susceptible patients. We directly measured the force applied to the base of the tongue as a surrogate for the stress response. Force measurements were obtained using three FlexiForce Sensors(®) (Tekscan Inc, Boston, MA, USA) attached along the concave surface of each laryngoscope blade. ⋯ Complete data were available for 23 patients. Compared with the Macintosh, we observed lower median (IQR [range]) peak force (9 (5-13 [3-25]) N vs 20 (14-28 [4-41]) N; p = 0.0001), average force (5 (3-7 [2-19]) N vs 11 (6-16 [1-24]) N; p = 0.0003) and impulse force (98 (42-151 [26-444]) Ns vs 150 (93-207 [17-509]) Ns; p = 0.017) with the GlideScope. Our study shows that the peak lifting force on the base of the tongue during laryngoscopy is less with the GlideScope videolaryngoscope compared with the Macintosh laryngoscope.