British journal of anaesthesia
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Randomized Controlled Trial
Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia.
This randomized, double-blind, prospective study was undertaken to evaluate the effects of magnesium sulphate on anaesthetic requirements and postoperative analgesia in patients undergoing total i.v. anaesthesia (TIVA). ⋯ I.v. magnesium sulphate during TIVA reduced rocuronium requirement and improved the quality of postoperative analgesia.
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Review Meta Analysis
Closed tracheal suction systems for prevention of ventilator-associated pneumonia.
We have assessed the evidence that closed tracheal suction systems (TSS) prevent ventilator-associated pneumonia (VAP), using a meta-analysis of randomized controlled trials (RCTs). We searched PubMed and Cochrane databases to identify RCTs that compared closed with open TSS for the management of mechanically ventilated (MV) patients. Nine RCTs were included in the meta-analysis. ⋯ The compared groups did not differ with respect to mortality (OR=1.04, 95% CI 0.78-1.39) or intensive care unit (ICU) length of stay [two RCTs: 12.3 (sd 1.1) vs 11.5 (1.4) days and 15.6 (13.4) vs 19.9 (16.7) days]. Suctioning with closed systems was associated with longer MV duration (weighted mean differences: 0.65 days, 95% CI 0.28-1.03) and higher colonization of the respiratory tract (OR=2.88, 95% CI 1.50-5.52) than open TSS. The available evidence suggests that closed as opposed to open TSS usage did not provide any benefit on VAP incidence, mortality, or ICU stay of MV patients.
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Comparative Study
Effect of chest compressions on the time taken to insert airway devices in a manikin.
Resuscitation guidelines recommend that chest compressions should continue throughout attempts to place airway devices. Few data support the use of the tracheal tube over supraglottic airway devices (SADs) during cardiopulmonary arrest. This study was designed to evaluate the speed with which different airway devices could be placed with and without interrupting chest compressions. ⋯ Our results show that continuing chest compressions has a minor effect on time for tracheal intubation and until clear human data are available the recommendation to intubate without interrupting CPR is therefore justified. The PLMA and igel (SADs with a gastric drain tube) were both faster to insert than the cLMA and offer additional benefits. They should be considered for use in CPR.
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Multicenter Study
Influence of transactive memory on perceived performance, job satisfaction and identification in anaesthesia teams.
There is an increasing awareness in the medical community that human factors are involved in effectiveness of anaesthesia teams. Communication and coordination between physicians and nurses seems to play a crucial role in maintaining a good level of performance under time pressure, particularly for anaesthesia teams, who are confronted with uncertainty, rapid changes in the environment, and multi-tasking. The aim of this study was to examine the relationship between a specific form of implicit coordination--the transactive memory system--and perceptions of team effectiveness and work attitudes such as job satisfaction and team identification. ⋯ These findings provided empirical evidence of the existence of a transactive memory system among real anaesthesia teams, and highlight the need to investigate whether transactive memory is actually linked with objective measures of performance.
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Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. ⋯ Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.