Anaesthesia
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We have developed an ultrasound probe through the centre of which an epidural needle can pass, intended to reduce the rate of contact between bone and needle during epidural insertion. We tested the ability of this probe to identify the lumbar interspace, using A-mode ultrasound, in a submerged plastic model, a porcine phantom and five human volunteers. ⋯ The human study also showed that the maximum bone echo was at least three times stronger than the interspace echo. Axial ultrasound guidance, with the needle passing through the probe, offers a method for reducing bone contact during epidural insertion.
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The objective of this study was to estimate the minimal effective anaesthetic concentrations of ropivacaine required to block the femoral nerve in 90% of patients. Forty-five patients who had knee surgery received ultrasound-guided femoral nerve block using 15 ml ropivacaine. The ropivacaine concentration given to a patient relied on the efficacy of the block in the previous patient, using the biased-coin design up-down sequential method. ⋯ Successful block was defined as complete sensory and motor block before surgery together with pain-free surgery. The minimal effective ropivacaine concentration was estimated to be 0.167% w/v (95% CI 0.14-0.184%). Perineural injection of 15 ml ropivacaine 0.167% w/v under ultrasound guidance can provide successful femoral nerve block in 90% of patients.
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Randomized Controlled Trial
The effects of a displayed cognitive aid on non-technical skills in a simulated 'can't intubate, can't oxygenate' crisis.
The use of a cognitive aid improves the performance of non-technical skills during simulated 'can't intubate, can't oxygenate' crisis.
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Randomized Controlled Trial Comparative Study
A prospective randomised comparison of two insertion methods for i-gel(™) placement in anaesthetised paralysed patients: standard vs rotational technique.
In this prospective randomised study, we compared two techniques for i-gel(™) insertion. One hundred and eighty-one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i-gel was inserted using the standard technique. ⋯ The mean (SD) insertion time was longer (26.9 (14.5) s vs. 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cm H2O vs. 27.1 (9.4) cm H2O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs. 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i-gel insertion.