Anaesthesia
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Randomized Controlled Trial
Effect of cricoid pressure on placement of the I-gel(™) : a randomised study.
We studied 40 adult patients to see if cricoid pressure affected placement of the I-gel(™). In a randomised crossover design, the i-gel was placed with and without cricoid pressure, and we compared the success rate of adequate ventilation through the i-gel, time to placement and the rate of optimal position of the device between the two circumstances. ⋯ The time to achieve adequate ventilation was significantly longer (p < 0.001) with cricoid pressure than without (median difference 8 s; 95% CI for median difference 3-12 s). Cricoid pressure significantly decreases the success rate of ventilation through the i-gel, but the success rate of ventilation through the i-gel is reasonably high.
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We investigated whether laparoscopic vs open surgical approaches affected the duration of neuromuscular blockade following a single bolus dose of rocuronium. Fifty-three female patients underwent either laparoscopic or open gynaecological surgery. ⋯ Changes in liver function both before surgery and at 24 h postoperatively were similar between the two groups (p > 0.05). Our findings suggest that neuromuscular blockade may be prolonged following a single bolus dose of rocuronium given during laparoscopic procedures.
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Thromboelastography is used for assessment of coagulation and to guide administration of blood products peri-operatively. There is currently no method of standardisation in the UK, nor an approved method of proving quality. We investigated the reproducibility of thromboelastography by testing whole blood with no coagulation abnormality in three phases. ⋯ Further examination of the results indicated less variation where analysis was performed on blood taken from the same kaolin vial compared with results from different vials. Our preliminary study indicates that R- and K-times may be highly variable, which we hypothesise may be due to variable mixing of blood and kaolin. We intend to repeat this study in the context of coagulopathy, where variability in results could potentially impact upon transfusion practice.