British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study
Iontophoretic transdermal system using fentanyl compared with patient-controlled intravenous analgesia using morphine for postoperative pain management.
The fentanyl iontophoretic transdermal system (fentanyl ITS) enables needle-free, patient-controlled analgesia for postoperative pain management. This study compared the efficacy, safety, and ease of care of fentanyl ITS with patient-controlled, i.v. analgesia (PCIA) with morphine for postoperative pain management. ⋯ Fentanyl ITS and morphine PCIA were comparably effective and safe.
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Randomized Controlled Trial Comparative Study
Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve.
We tested the hypothesis that ultrasound guidance may reduce the minimum effective anaesthetic volume (MEAV50) of ropivacaine 0.5% required to block the femoral nerve compared with nerve stimulation guidance. ⋯ Ultrasound guidance provided a 42% reduction in the MEAV of ropivacaine 0.5% required to block the femoral nerve as compared with the nerve stimulation guidance.
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Randomized Controlled Trial
Removal of the laryngeal tube in children: anaesthetized compared with awake.
Laryngeal tube (LT) is a useful airway device in children, but there is no objective evidence that removal of LT in awake state is better than in anaesthetized state. So, we compared the incidence of respiratory adverse events after the removal of LT, either under anaesthesia or on awakening. ⋯ LT removal in anaesthetized state reduced cough, hypersalivation, and prevented tube displacement and hypoxia. Upper airway obstruction in the anaesthetized state should be predicted and managed with chin or jaw lifting.
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Anatomical dead space is usually measured using the Fowler equal area method. Alternative methods include the Hatch, Cumming, and Bowes methods, in which first, second, and third order polynomials, respectively, fitted to an expired CO2 volume vs expired volume curve, intercept the x-axis at the anatomical dead space. This study assessed systematic errors and susceptibility to noise of the Fowler, Hatch, Cumming, and Bowes dead spaces calculated over 40-80% of the CO2 expirogram. ⋯ The Fowler method shows greatest susceptibility to measurement noise and the Hatch method exhibits the largest systematic error. The Cumming method, which exhibits both low bias and low noise susceptibility, is preferred for estimating anatomical dead space from CO2 expirograms.
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Selenium plays an important role in defence against acute illness. We investigated, in intensive care unit (ICU) patients, the time course of plasma selenium concentrations and their relationship to systemic inflammatory response syndrome (SIRS), organ dysfunction/failure, infection, and ICU outcome. ⋯ In critically ill surgical patients, plasma selenium concentrations are generally low with a greater decrease during the ICU stay in patients with organ failure, especially when attributed to infection. Lower plasma selenium concentrations are associated with more tissue damage, the presence of infection or organ dysfunction/failure, and increased ICU mortality.