Anaesthesia
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Cardiac output can be measured non-invasively using supra-sternal Doppler (USCOM, Sydney, NSW, Australia). However, scanning can be difficult in practice in older patients, the reason for which has not been elucidated previously. Chest radiographs from 60 previously studied anaesthetised patients were reviewed and scored for aortic unfolding, enlargement and calcification, and cardiac enlargement. ⋯ Twenty patients who were difficult to scan, aged 60-88 years, had mean (SD) radiological scores of 5.9 (2.5) out of 12, while 20 adult controls, 40-60 years, and 20 older patients who were easy to scan, 60-80 years, had radiological scores of 0.9 (1.1) and 1.7 (1.4), respectively (p < 0.001). Over 75% of the patients who were difficult to scan had two or more radiological features suggestive of aortic unfolding and cardiac enlargement. Morphological or anatomical changes associated with ageing within the upper chest play an important part in the success of using supra-sternal Doppler in older patients.
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During emergency care, the ability to ventilate the patient's lungs is a crucial skill. Supraglottic airway devices have an established role in emergency care, and manikin trials have shown that placement is easy even for inexperienced users. However, there is current discussion as to what extent these results can be transferred to patients. ⋯ For 26 students who succeeded with both devices, the tidal volume was lower using the facemask, 431 (192) ml compared with the LMA-Supreme 751 (221) ml (p = 0.001), but the time to successful ventilation did not differ, 60.0 (26.2) s vs 57.3 (26.6) s (p = 0.71). We conclude that the results obtained in manikin studies cannot be transferred directly to the clinical situation and that guidelines should take this into account. Based on our findings, a supraglottic airway device may be preferable to a facemask as the first choice for inexperienced emergency caregivers.
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We present a novel ultrasound-guided regional anaesthetic technique that may achieve complete paraesthesia of the hemithorax. This technique may be a viable alternative to current regional anaesthetic techniques such as thoracic paravertebral and central neuraxial blockade, which can be technically more challenging and have a higher potential side-effect profile. We performed the serratus block at two different levels in the midaxillary line on four female volunteers. ⋯ There were no side-effects noted in this initial descriptive study. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for the serratus plane block to provide analgesia following surgery on the thoracic wall. We suggest that this novel approach appears to be safe, effective, and easy to perform, and is associated with a low risk of side-effects.
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Patients' involvement in all decision processes is becoming increasingly important in modern healthcare. Patient satisfaction is a sensitive measure of a well-functioning health service system. The objective of this review is to discuss patient satisfaction as part of outcome quality, to define the somewhat abstract term 'satisfaction', and to discuss the role of surrogate markers within the field of satisfaction with anaesthesia care. We critically discuss what is relevant to satisfy patients with anaesthesia care, and we provide guidance on improving satisfaction.