British journal of anaesthesia
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Real-time two-dimensional (2D) ultrasound can be used to facilitate neuraxial anaesthesia. Four-dimensional (4D) ultrasound allows the use of multiple imaging planes and three-dimensional reconstruction of ultrasound data. We assessed how 4D ultrasound could be used to perform epidural catheter insertion in a cadaver model. We then also compared 4D ultrasound and a previously described 2D technique in real-time epidural catheterization. ⋯ The study demonstrates that 4D ultrasound can be used for real-time epidural catheter insertion and has both advantages and limitations compared with the 2D technique. Four-dimensional ultrasound has the potential to improve operator orientation on the vertebral column. However, this comes at the price of decreased resolution, frame rate, and needle visibility. Prospective evaluation of the importance of an acoustic window in neuraxial anaesthesia is required.
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Plethysmographic variability index (PVI) is an accurate predictor of fluid responsiveness in mechanically ventilated patients. However, the site of measurement of the plethysmographic waveform impacts its morphology and its respiratory variation. The goal of this study was to investigate the ability of PVI to predict fluid responsiveness at three sites of measurement (the forehead, ear, and finger) in mechanically ventilated patients under general anaesthesia. ⋯ PVI can predict fluid responsiveness in anaesthetized and ventilated subjects at all three sites of measurement. However, the threshold values for predicting fluid responsiveness differ with the site of measurement. These results support the use of this plethysmographic dynamic index in the cephalic region when the finger is inaccessible or during states of low peripheral perfusion.
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Cell salvage is used in obstetric surgery as part of a blood conservation strategy in our Trust. This carries a theoretical risk of amniotic fluid embolism and also a risk of fetal red cells being present in the re-infusion, resulting in alloimmunization. In this study, we attempted to quantify the risk of antibody formation from re-infusion of autologous blood after Caesarean section. ⋯ The implementation of a blood conservation strategy which includes the use of intraoperative cell salvage appears safe and can contribute to a reduction in the number of blood transfusions to the obstetric population. We remain uncertain of the significance of fetal red cell contamination.
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The aim of this study was to explore anaesthetists' perceptions and experience of the implementation of multi-source feedback (MSF) for their performance review. ⋯ The anaesthetists interviewed in this study accepted performance review and the role of MSF in it. Anaesthetists thought anonymity an important feature of MSF, and viewed the process as an opportunity for self-improvement. To the extent that MSF was viewed by the anaesthetists as surveillance by management, this was seen as being largely benign. Rather a view of the acceptance of self-responsibility for using the information gathered to improve their own performance was held by the majority of those interviewed. While broad sampling of sources within and outside anaesthesia was desired, most value was placed on feedback from both nurses and trainees within anaesthesia. The value of feedback from surgeons was contentious, and this may reflect underlying issues with this important relationship that are yet to be explored.
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The transpulmonary thermodilution (TPTD) technique for measuring cardiac output (CO) has never been validated in the presence of a left-to-right shunt. ⋯ The TPTD technique is a feasible method of measuring CO in paediatric animals with a left-to-right shunt.