British journal of anaesthesia
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Case Reports
Use of the McGrath videolaryngoscope in the management of difficult and failed tracheal intubation.
Difficult laryngoscopy and failed tracheal intubation are associated with complications which can be serious, and on occasion, life-threatening. We report three cases of difficult and failed tracheal intubation using a conventional Macintosh laryngoscope in which tracheal intubation was accomplished swiftly and easily using a new design of videolaryngoscope, the McGrath.
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The relationship between measures of drug effect such as bispectral index (BIS) and end-tidal (ET) levels of anaesthetic agents is described by the 'effect site equilibrium half-time', t(1/2)(ke0). There are limited data available on sevoflurane t(1/2)(ke0) during routine anaesthesia and surgery. Preliminary observations suggested t(1/2)(ke0) for the degree of hypnosis as estimated by BIS is different from that for burst suppression of the electroencephalograph, occurring at 'deep' levels of anaesthesia. This study aimed to determine and compare t(1/2)(ke0) for these two 'effects'. ⋯ The different values of t(1/2)(ke0) for these effects suggest different sites or mechanisms of action. These results also establish values of t(1/2)(ke0) which can be used to provide the real-time estimates of effect-site sevoflurane concentration in clinical practice.
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We tested the hypothesis that sodium nitroprusside (SNP) might improve the impairment of hepatosplanchnic microcirculatory blood flow (MBF) in septic shock. ⋯ In a resuscitated porcine model of the early phase of septic shock, SNP improved ileal mucosal MBF but required a concomitant increase in fluid and norepinephrine supplements to maintain constant systemic haemodynamic parameters.
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Review Meta Analysis
Meta-analysis of the effect of heart rate achieved by perioperative beta-adrenergic blockade on cardiovascular outcomes.
Acute perioperative beta-adrenergic blockade may be cardioprotective in the high-risk cardiac patient for major non-cardiac surgery. We have investigated the association between the heart rate achieved with perioperative beta-blockade and the incidence of perioperative cardiac complications. ⋯ This meta-analysis cannot confirm that heart rate control with beta-adrenergic blockade is cardioprotective. A randomized controlled trial examining the effect of tight perioperative heart rate control with beta-adrenergic blockade on clinically important outcomes and adverse events is warranted.