British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized crossover comparison of ProSeal Laryngeal Mask Airway with Laryngeal Tube Sonda during anaesthesia with controlled ventilation.
The Laryngeal Tube Sonda (LTS) is a supraglottic airway which, like the ProSeal Laryngeal Mask Airway (PLMA), incorporates a drain tube. We compared the performances of LTS and PLMA during controlled ventilation anaesthesia. ⋯ The difference in seal pressure between devices was clinically unimportant. However, the LTS had an unexpectedly high failure rate. PLMA performance exceeded LTS performance in many clinically useful measures. The PLMA has greater clinical utility than the LTS during controlled ventilation.
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Comparative Study
Dysaesthesia associated with sternotomy for heart surgery.
Chronic pain occurs in 40-50% patients following cardiac surgery. Dysaesthesia, either in the form of heightened or diminished skin sensation, are frequently associated with chronic neuropathic pain. Therefore, dysaesthesia in the early postoperative period may predict chronic pain. However, the character and causes of dysaesthesia in the early postoperative period are unknown. The aim of this study was to investigate the incidence, extent, and causes of dysaesthesia following cardiac surgery by sternotomy. ⋯ Dysaesthesia is common in the early postoperative period following cardiac surgery using a sternotomy and is associated with CABG surgery. The association with severity of pain may indicate a neuropathic element that is unrelieved by conventional opioid analgesia.
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Comparative Study
Use of a stimulating catheter for total knee replacement surgery: preliminary results.
There is continuing debate as to whether the use of electrical stimulation that aids in localizing nerves is also beneficial for optimizing placement of nerve catheters and lead to improved clinical outcomes, such as reductions in pain scores and opioid consumption. ⋯ The practical advantages of the stimulating catheter, as reported by previous investigators, were not obvious in this clinical situation. In terms of outcome measures such as pain scores and morphine consumption, we found no significant differences between stimulating and non-stimulating catheters.
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This study was conducted to determine whether replacement of fibrinogen is useful in reversing dilutional coagulopathy following severe haemorrhage and administration of colloids. ⋯ Replacing 65% of the estimated blood volume with gelatin in swine resulted in dilutional coagulopathy; subsequent fibrinogen administration improved clot formation and reduced blood loss significantly.
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Case Reports
Increases in bispectral index lead to interventions that prevent possible intraoperative awareness.
In this case a woman underwent a cervical laminectomy with a total i.v. anaesthesia technique and during her care two problems occurred with propofol delivery. In both cases, bispectral index increases alerted caregivers to the decreased propofol delivery and allowed them to make corrections in a manner timely enough to prevent the occurrence of awareness during anaesthesia. The case illustrates how intraoperative processed electroencephalographic monitoring may decrease the incidence of recall of awareness following surgery.