Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope(®) with conventional blind placement.
Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope® , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). ⋯ In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.
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Sarcopenia is the degenerative loss of core muscle mass. It is an aspect of frailty, which is associated with increased rates of peri-operative harm. ⋯ In multivariate analysis, mortality hazard (95%CI) was independently associated with: age, 1.06 (1.01-1.13) per year, p = 0.03; and the adjusted area of the left psoas muscle, 0.94 (0.81-1.01) per mm2 .kg-0.83 , p = 0.08. Shortened hospital stay was independently associated with haemoglobin concentration and adjusted left psoas muscle area, hazard ratio (95%) 1.01 (1.00-1.02) per g.l-1 and 1.05 (1.02-1.07) per mm2 .kg-0.83 , p = 0.04 and 0.001, respectively.
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There is disagreement regarding the benefits of goal-directed therapy in moderate-risk abdominal surgery. Therefore, we tested the hypothesis that the addition of non-invasive cardiac index and pulse pressure variation monitoring to mean arterial pressure-based goal-directed therapy would reduce the incidence of postoperative complications in patients having moderate-risk abdominal surgery. In this pragmatic multicentre randomised controlled trial, we randomly allocated 244 patients by envelope drawing in a 1:1 fashion, stratified per centre. ⋯ Overall complication rates were similar (42/94 (44.7%) vs. 38/81 (46.9%) in the control and CI-PPV groups, respectively; p = 0.95). The CI-PPV group had lower mean (SD) pulse pressure variation values (9.5 (2.0)% vs. 11.9 (4.6)%; p = 0.003) and higher mean (SD) cardiac indices (2.76 (0.62) l min-1 .m-2 vs. 2.53 (0.66) l min-1 .m-2 ; p = 0.004) than the control group. In moderate-risk abdominal surgery, we observed no additional value of cardiac index and pulse pressure variation-guided haemodynamic therapy to mean arterial pressure-guided volume therapy with regard to postoperative complications.
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We investigated the strength of commonly used spinal needles in relation to the amount of deformation, and registered forces during standardised testing. We investigated differences between manufacturers for the same length and gauge of Luer and non-Luer needles, and examined the effect of the internal stylet in terms of needle strength. A specialised rig was designed to perform the testing in both the horizontal and axial plane, reflecting common industrial tests and clinical use. ⋯ The presence of the internal stylet resulted in significantly greater toughness in many needles, but had little effect on the degree of deformation. Comparison of Luer and non-Luer needles of the same brand and size showed few significant differences in strength. This result is reassuring, given the imminent change from Luer to non-Luer needles that is to occur in the UK.
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The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. ⋯ Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness.