Anaesthesia
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Review Meta Analysis
A systematic review and meta-analysis of ultrasound versus electrical stimulation for peripheral nerve location and blockade.
We systematically reviewed peripheral nerve blockade guided by ultrasound versus electrical stimulation. We included 26 comparisons in 23 randomised controlled trials of 2125 participants. Ultrasound reduced the rate of pain during the procedure, relative risk (95% CI) 0.60 (0.41-0.89), p = 0.01. ⋯ The rate of rescue was unaffected by the addition of electrical stimulation to ultrasound, relative risk (95% CI) 1.07 (0.54-2.10), p = 0.85. Ultrasound, with or without electrical stimulation, reduced the pooled rate of vascular puncture, relative risk (95% CI) 0.23 (0.15-0.37), p < 0.0001. There was no difference in the rate of postoperative neurological side-effects, relative risk (95% CI) 0.76 (0.53-1.09), p = 0.13.
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Multicenter Study
Transthoracic echocardiographic assessment of haemodynamics in severe pre-eclampsia and HIV in South Africa.
Haemodynamic and cardiac structural changes in severe pre-eclampsia and in pregnant women with human immunodeficiency virus (HIV) infection have not been clearly established. We performed transthoracic echocardiography on 105 women. Women with pre-eclampsia demonstrated (mean (SD), untreated vs treated) preserved fractional shortening (40 (7.1)% vs. 41 (8.6)%), a non-dilated left ventricle (4.5 (0.49) cm vs. 4.4 (0.44) cm), increased mitral valve E/septal e' (10.5 (3.3) vs. 10.6 (2.8)), and preserved tricuspid annular plane systolic exertion (2.6 (0.36) cm vs. 2.4 (0.51) cm). ⋯ Fractional shortening (< 28%) was reduced in 10% of healthy women, and mitral valve E/septal e' ratios were > 8 in 38% of that group. Women with pre-eclampsia demonstrated preserved systolic function, with diastolic dysfunction. Women with HIV demonstrated reduced left and right ventricular systolic function, with increased ventricular dilatation.
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Difficult airway practice guidelines include the use of a supraglottic airway device as part of the armamentarium to provide and maintain ventilation and oxygenation. We retrospectively reviewed 14 480 patients aged ≥ 18 years who underwent general anaesthesia. ⋯ Adverse respiratory events including oxygen desaturation, hypercapnoea, laryngospasm, and bronchospasm occurred in 17 patients (22%). The incidence of difficult ventilation via a supraglottic airway device was 0.5% in a large cohort of South-East Asian patients.
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Serious complications have been described during oxygenation of patients with airway exchange catheters, due to catheter malpositioning, accidentally applied high airway pressures or high delivered volumes. In this in-vitro study, we analysed gas flow through various airway exchange catheters and described its dependence on driving pressure and entrainment. ⋯ Measured gas flow values differed significantly from values calculated according to the Hagen-Poiseuille equation. Although flow restriction in ventilators and small-bore connectors will limit gas flow, large gas volumes may be unintentionally applied via the airway exchange catheters, leading to serious complications.
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The purpose of this study was to investigate the effects of dexmedetomidine on biventricular systolic and diastolic function using transoesophageal echocardiography. Cardiac function was assessed in 30 healthy patients who received total intravenous anaesthesia with propofol and remifentanil. ⋯ In contrast, no changes were observed in biventricular systolic and diastolic indices in either group, and there were no inter-group differences at any time point. Dexmedetomidine, as an adjuvant to total intravenous anaesthesia, does not impair biventricular systolic and diastolic function in healthy patients, but decreases cardiac output by reducing heart rate.