Anaesthesia
-
Peri-operative melatonin may cause small reductions in pre-operative anxiety and post-operative pain.
pearl -
Randomized Controlled Trial
Supplementation of standard pre-oxygenation with nasal prong oxygen or machine oxygen flush during a simulated leak scenario.
The presence of a facemask leak significantly reduces the effectiveness of pre-oxygenation and increases the risk of post-induction hypoxia. We randomly assigned 24 healthy volunteers to a six-period crossover trial with and without a simulated facemask leak. Pre-oxygenation was performed using a standard anaesthesia machine circuit supplemented either by nasal prong oxygen or by anaesthesia machine flush oxygen. ⋯ With a simulated facemask leak introduced, the mean (SD) end-tidal oxygen fraction with the 3-min tidal breath technique was 74.7 (9.3)% compared with 57.5 (6.2%) for the 8 deep breath technique with 3-min tidal breathing and a leak. End-tidal oxygen fractions increased by 11.0% (95% CI 7.8-14.3%) (p < 0.0001) with the addition of nasal prong oxygenation and 16.8% (13.6-20.0%) (p < 0.0001) with machine oxygen flush compared with standard pre-oxygenation. When a leak is present, 3-min tidal breathing with either nasal prong or anaesthesia machine flush oxygenation is an effective pre-oxygenation method, and preferable to the 8 deep breath method.
-
This study aimed to gauge the opinions of patients' next of kin regarding transfer of patients from the specialist 'Hub' intensive care unit, to 'Spoke' intensive care units near home. We included 213 consecutive patients with severe trauma or severe acute neurological conditions admitted to the Hub intensive care unit over a 21-month period, who were repatriated to Spoke intensive care units for ongoing intensive care. ⋯ The next of kin's preference was associated with severe acute neurological conditions (p ≤ 0.0001). Although centralised Hub & Spoke intensive care unit networks are appropriate to ensure specialised care, repatriation to local hospitals may not be appropriate for patients with severe neurological conditions.
-
Accidental awareness during general anaesthesia with recall is a potentially distressing complication of general anaesthesia that can lead to psychological harm. The 5th National Audit Project was designed to investigate the reported incidence, predisposing factors, causality and impact of accidental awareness. A nationwide network of local co-ordinators across all UK and Irish public hospitals reported all new patient reports of accidental awareness to a central database, using a system of monthly anonymised reporting over a calendar year. ⋯ Patient experience and sequelae were categorised using current tools or modifications of such. The 5th National Audit Project methodology may be used to assess new reports of accidental awareness during general anaesthesia in a standardised manner, especially for the development of an ongoing database of case reporting. This paper is a shortened version describing the protocols, methods and data analysis from 5th National Audit Project - the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.