Anaesthesia
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Randomized Controlled Trial
Effect of penehyclidine hydrochloride on the incidence of intra-operative awareness in Chinese patients undergoing breast cancer surgery during general anaesthesia.
Intra-operative awareness can lead to serious adverse psychological consequences. We conducted a prospective, randomised, double-blinded trial in 920 patients undergoing breast cancer surgery under bispectral index-guided total intravenous anaesthesia to evaluate the effect of penehyclidine hydrochloride on intra-operative awareness. Patients were randomly divided to receive 0.01 mg.kg(-1) penehyclidine hydrochloride or saline intravenously 30 min before surgery. ⋯ We found no differences in depth of anaesthesia and patients' pre-operative anxiety levels between the two groups. The incidence of awareness with penehyclidine hydrochloride (0/456 patients; 0%) was significantly lower than with saline (5/452; 1.1%), p = 0.030. We conclude that penehyclidine hydrochloride reduced the incidence of intra-operative awareness in patients undergoing breast cancer surgery during general anaesthesia.
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Ventilator-induced lung injury (VILI) is the phenomenon by which mechanical ventilation exacerbates lung injury in critically ill patients. It is particularly relevant for those suffering from acute respiratory distress syndrome, in which the iatrogenic injury caused by VILI contributes to their high mortality. ⋯ However, it is our belief that the identification of inflammatory mediators that are crucial during VILI, and thus may make useful therapeutic targets, has become obscured by the wide variety of pre-clinical animal models of VILI reported in the literature. We aim here to summarise some of our work addressing this issue over the last 10 years, and thus, we hope, make interpretation of a convoluted field a little clearer.
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Randomized Controlled Trial Comparative Study
The McGrath® Series 5 videolaryngoscope vs the Macintosh laryngoscope: a randomised, controlled trial in patients with a simulated difficult airway.
We compared the McGrath® Series 5 videolaryngoscope with the Macintosh laryngoscope in a simulated difficult airway, using manual in-line stabilisation in 88 anaesthestised patients of ASA physical status 1-2. The primary outcome was laryngoscopic view. Secondary outcomes included rates of successful tracheal intubation and complications. ⋯ In 66 out of 88 patients (75%), the McGrath improved the glottic view by one to three grades compared with the Macintosh (p < 0.001). Intubation of the trachea was successful in all patients using the McGrath, while the Macintosh was successful in 26 (59%, p < 0.001). There was no significant difference in the complication rates between the devices.
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Eighteen published trials have examined the use of neuraxial magnesium as a peri-operative adjunctive analgesic since 2002, with encouraging results. However, concurrent animal studies have reported clinical and histological evidence of neurological complications with similar weight-adjusted doses. The objectives of this quantitative systematic review were to assess both the analgesic efficacy and the safety of neuraxial magnesium. ⋯ The time to first analgesic request increased by 11.1% after intrathecal magnesium administration (mean difference: 39.6 min; 95% CI 16.3-63.0 min; p = 0.0009), and by 72.2% after epidural administration (mean difference: 109.5 min; 95% CI 19.6-199.3 min; p = 0.02) with doses of between 50 and 100 mg. Four trials monitored for neurological complications: of the 140 patients included, only a 4-day persistent headache was recorded. Despite promising peri-operative analgesic effect, the risk of neurological complications resulting from neuraxial magnesium has not yet been adequately defined.
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During the past decade, there has been a dramatic increase in the number of thoracic surgical procedures carried out in the UK. The current financial climate dictates that more efficient use of resources is necessary to meet escalating demands on healthcare. One potential means to achieve this is through the introduction of enhanced recovery protocols, designed to produce productivity savings by driving reduction in length of stay. ⋯ We performed a comprehensive search for published work relating to the peri-operative management and optimisation of patients undergoing thoracic surgery, and divided these into appropriate areas of practice. We have reviewed the specific interventions that may be included in an enhanced recovery programme, including: pre-optimisation; minimising fasting time; thrombo-embolic prophylaxis; choice of anaesthetic and analgesic technique and surgical approach; postoperative rehabilitation; and chest drain management. Using the currently available evidence, the design and implementation of an enhanced recovery programme based on this review in selected patients as a package of care may reduce morbidity and length of hospital stay, thus maximising utilisation of available resources.