British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
A double-blinded randomized evaluation of alfentanil and morphine vs fentanyl: analgesia and sleep trial (DREAMFAST).
Patients using fentanyl patient-controlled analgesia (PCA), the standard first-line choice in our hospitals, commonly complain of postoperative sleep disruption due to pain. The aim of this study was to determine whether the PCA combination of alfentanil and morphine, which provides longer analgesia without compromising onset speed, would improve postoperative pain-related sleep interference. ⋯ Despite better early postoperative analgesia, pain-related sleep interference was not improved by the PCA combination of alfentanil and morphine. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY: Ref: ACTRN12608000118303.
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In patients receiving an infusion of norepinephrine, the relationship between the amplitude of the oximeter plethysmographic waveform and stroke volume may be variable and quality of the waveform might be reduced, compared with patients not receiving norepinephrine. We assessed the reliability of the pleth variability index (PVI), an automatic measurement of the respiratory variation of the plethysmographic waveform, for predicting fluid responsiveness in patients receiving norepinephrine infusions. ⋯ PVI was less reliable than PPV and SVV for predicting fluid responsiveness in critically ill patients receiving norepinephrine. In addition, PVI could not be measured in a significant proportion of patients. This suggests that PVI is not useful in patients receiving norepinephrine.
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Comparative Study
Left ventricular volume and ejection fraction assessment with transoesophageal echocardiography: 2D vs 3D imaging.
Developments in transducer technology have enabled the use of three-dimensional transoesophageal echocardiography (3D TOE) in the operating theatre. Transthoracic echocardiography (TTE) 3D left ventricular (LV) volumes and ejection fraction (EF) agree better with magnetic resonance imaging (MRI) measurements, with less intra- and inter-observer variability compared with 2D. This has not been validated with 3D TOE. The aim of this study was to assess the bias, limits of agreement, and reproducibility of 3D TOE and 2D TOE LV volumes and EF in cardiac surgical patients. ⋯ The intraoperative use of 3D TOE to estimate LV volumes and EF has small bias compared with 2D assessments, wide limits of agreement, and no clear advantages compared with standard 2D TOE imaging in terms of LV volume and EF assessment.
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Randomized Controlled Trial
Long-term quality of sleep after remifentanil-based anaesthesia: a randomized controlled trial.
Clinical and pre-clinical data agree that opioids disrupt sleep architecture. Recently, remifentanil has been suggested to cause possible long-term disturbances of sleep quality. This randomized controlled clinical trial was designed to substantiate or refute a possible long-term effect of remifentanil on the quality of sleep. ⋯ The intraoperative use of remifentanil in a general patient population does not significantly alter the quality of sleep in the postoperative period. However, it may result in a significant reduction in the quality of sleep in patients before operation considered good sleepers. These changes were not observed in the group of patients receiving fentanyl. The relevance of these findings in terms of patient recovery and quality-of-life warrants further investigation. Trial Registration. ACTRN12610000362099.
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Randomized Controlled Trial Comparative Study
Ultrasound visual image-guided vs Doppler auditory-assisted radial artery cannulation in infants and small children by non-expert anaesthesiologists: a randomized prospective study.
Cannulation of the radial artery in infants and small children can be challenging, even for the most experienced providers. Utilizing Doppler to aid in radial artery cannulation has been well described. Recent studies have demonstrated the efficacy of ultrasound (US) image-guided vascular access techniques in the paediatric population. The utility of these two techniques, when used by non-expert personnel, has not been studied. ⋯ US-guided radial arterial cannulation in infants and small children provided a greater chance for success at the first attempt compared with the Doppler-assisted technique.