Anaesthesia
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Letter Case Reports
Tension gastrothorax presenting with dramatic ECG changes.
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Review Meta Analysis Comparative Study
A meta-analysis of the accuracy and precision of the ultrasonic cardiac output monitor (USCOM).
The ultrasonic cardiac output monitor is a non-invasive, continuous-wave Doppler monitor that can be used to measure cardiac output. Its accuracy and precision in peri-operative and critical care has been assessed with varied results. ⋯ The mean weighted bias was -0.39 l.min(-1) (95% CI -0.25 to -0.53 l.min(-1) ), precision 1.27 l.min(-1) and percentage error 42.7% (95% CI 38.5-46.9%). The ultrasonic cardiac output monitor achieved similar agreement with bolus thermodilution to that of other minimally invasive methods of peri-operative cardiac output monitoring, and may have a useful role in cardiac output monitoring.
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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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Hip fracture surgery is associated with a high rate of mortality and morbidity; heart disease is the leading cause and is often unrecognised and inadequately treated. Pre-operative focused transthoracic echocardiography by anaesthetists frequently influences management, but mortality outcome studies have not been performed to date. Mortality over the 12 months after hip fracture surgery, in 64 patients at risk of cardiac disease who received pre-operative echocardiography, was compared with 66 randomised historical controls who did not receive echocardiography. ⋯ Hazard of death was also reduced with pre-operative echocardiography over 12 months after adjustment for known risk factors (hazard ratio 0.41, 95% CI 0.2-0.85, p=0.016). Pre-operative echocardiography was not associated with a delay in surgery. These data support a randomised controlled trial to confirm these findings.