British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Development of a difficulty score for spinal anaesthesia.
Multiple attempts at spinal puncture may be hazardous. Accurate preoperative prediction of difficulty adds to the delivery of high quality care. This clinical trial was designed to: (i). determine the predictive performance of difficulty variables; (ii). compare senior and junior anaesthetists; (iii). develop a score to predict difficulty during the performance of spinal anaesthesia. ⋯ Spinal bony landmarks and radiological characteristics of the lumbar vertebrae are independent predictors of difficulty during spinal anaesthesia. There is no difference between senior and junior anaesthetists. Grade 4 is the difficulty score at or above which difficulty is expected.
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Standardized scenarios can be used for performance assessments geared to the level of the learner. The purpose of this study was to validate checklists used for the assessments of medical students' performance using high-fidelity patient simulation. ⋯ Five scenarios developed for this study were shown to be valid when using the faculty criteria for expected performance level.
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Randomized Controlled Trial Clinical Trial
Effect of three anaesthetic techniques on isometric skeletal muscle strength.
Our aim was to quantify human involuntary isometric skeletal muscle strength during anaesthesia with propofol, sevoflurane, or spinal anaesthesia using bupivacaine. ⋯ At clinically relevant concentrations, propofol and sevoflurane did not influence involuntary isometric skeletal muscle strength in adults, whereas spinal anaesthesia reduced strength by about 20%. Muscle strength assessment using a device such as described here provided reliable results and should be considered for use in other scientific investigations to identify potential effects of anaesthetic agents.
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We describe the use of transcranial Doppler (TCD) monitoring during laparoscopic resection of an ovarian cyst in a young woman who previously underwent ventriculoperitoneal shunting for hydrocephalus. Shunt function was not altered by pneumoperitoneum, except during transient episodes of high intra-abdominal pressure. The role of TCD monitoring during laparoscopic procedures in patients with cerebrospinal fluid shunt is discussed.
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Neuromuscular block is estimated by comparing the evoked peak twitch with a control value measured in the absence of neuromuscular block. In practice, this control value is often difficult to determine because repeated motor nerve stimulation enhances the evoked mechanical response of the corresponding muscle, resulting in an increased twitch response. This is known as twitch potentiation or the staircase phenomenon. It is probably the result of myosin light chain phosphorylation creating an increased twitch force for a given amount of Ca(2+) released at each action potential. Modelling of potentiation may improve studies of neuromuscular blocking agents using mechanomyography or accelerometry. ⋯ We conclude that a two-exponential model can predict the degree of twitch potentiation for the stimulation patterns and frequencies tested more accurately than a one-exponential model. However, if only one stimulation frequency is used, a one-exponential model can provide good accuracy. We illustrate that such a potentiation model can improve the ability of pharmacodynamic-pharmacokinetic neuromuscular block models to predict twitch response in the presence of a neuromuscular blocking agent.