Anaesthesia
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Toxic dose limits (mg.kg(-1)) for local anaesthetics based on body weight are well-established, but calculation of the maximum safe volume (ml) of a given agent and formulation is complex, and frequently results in errors. We therefore developed a nomogram to perform this calculation. We compared the performance of the nomogram with a spreadsheet and a general purpose calculator using simulated clinical data. ⋯ The nomogram produced fewer and smaller errors compared with the calculator. Our nomogram calculates the maximum safe volume (ml) of local anaesthetic to a clinically acceptable degree of accuracy. It facilitates rapid cross-checking of dosage calculations performed by electronic or other means at negligible cost, and can potentially reduce the incidence of local anaesthetic toxicity.
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Randomized Controlled Trial Comparative Study
A randomised controlled trial comparing incentive spirometry with the Acapella(®) device for physiotherapy after thoracoscopic lung resection surgery.
Lung resection surgery has been associated with numerous postoperative complications. Seventy-eight patients scheduled for elective video-assisted thoracoscopic lung resection were randomly assigned to receive standard postoperative care with incentive spirometry or standard care plus positive vibratory expiratory pressure treatment using the Acapella(®) device. ⋯ In addition, 37/39 patients (95%) stated a clear preference for the Acapella device. Postoperative treatment with the Acapella device did not improve pulmonary function after thoracoscopic lung resection surgery compared with incentive spirometry, but it may be more comfortable to use.
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Echocardiography has been widely adopted as a diagnostic and monitoring tool in cardiac anaesthesia and critical care. There is considerable interest in how echocardiography could be used to benefit patients in other areas of anaesthesia and peri-operative practice. The first part of review examines the impact and utility of echocardiography, while this second part is concerned with the matter of training and accreditation. ⋯ Some of these, such as Focused Intensive Care Echocardiography in the UK, have been developed into structured accreditation processes with embedded supervision. Learning opportunities are now emerging for anaesthetists who wish to acquire echocardiography skills--these encompass clinical, simulation and online resources. Whilst the roll-out of echocardiography for more widespread use in peri-operative management is a long-term project, it is now an appropriate time to consider how this may be achieved.
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The practice of checking the ability to mask ventilate before administering neuromuscular blocking drugs remains controversial. We prospectively evaluated the changes in the expired tidal volume during pressure-controlled ventilation (two-handed mask ventilation technique) as a surrogate marker to assess the ease of mask ventilation following administration of rocuronium. ⋯ The mean (SD) expired tidal volume before administration of rocuronium increased by 61 (13) ml at 2 min following onset of neuromuscular block (p < 0.001). This supports the concept that neuromuscular blockade induced by rocuronium facilitates mask ventilation.