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S Sinmyee, V J Pandit, J M Pascual, A Dahan, T Heidegger, G Kreienbühl, D A Lubarsky, J J Pandit
A decision by a society to sanction assisted dying in any form should logically go hand-in-hand with defining the acceptable method(s). Assisted dying is legal in several countries and we have reviewed the methods commonly used, contrasting these with an analysis of capital punishment in the USA. We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used. However, the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined...
February 20, 2019: Anaesthesia
C Lyons, M Callaghan
Apnoeic oxygenation refers to oxygenation in the absence of spontaneous respiration or mechanical ventilation. It has been described in humans for over half a century and has seen a resurgence in interest given its potential to delay oxygen desaturation during airway management, especially with the advent of high-flow nasal cannulae. This narrative review summarises our current understanding of the mechanisms of gas exchange during apnoeic oxygenation and its diverse range of clinical applications, including its use at induction of anaesthesia and for the facilitation of 'tubeless anaesthesia'...
February 19, 2019: Anaesthesia
P S Myles, J B Carlisle, B Scarr
In 2016 the World Health Organization recommended intra-operative ventilation with 80% inspired oxygen to reduce surgical site infection rates, based upon a meta-analysis of 15 randomised controlled trials, of which two were by Mario Schietroma's research group. Five trials by this group have been retracted for duplication, plagiarism, statistical error and lack of ethical approval. We analysed 40 papers by this group: 24 randomised controlled trials (5064 participants) and 16 observational studies (1847 patients)...
February 17, 2019: Anaesthesia
J-N Evain, A Perrot, A Vincent, J-C Cejka, C Bauer, A Duclos, T Rimmelé, J-J Lehot, M Lilot
Planning held before emergency management of a critical situation might be an invaluable asset for optimising team preparation. The purpose of this study was to investigate whether a brief planning discussion improved team performance in a simulated critical care situation. Forty-four pairs of trainees in anaesthesia and intensive care were randomly allocated to either an intervention or control group before participating in a standardised simulated scenario. Twelve different scenarios were utilised. Groups were stratified by postgraduate year and simulated scenario, and a facilitator was embedded in the scenario...
February 15, 2019: Anaesthesia
A B Lumb, C R Thomas
No abstract text is available yet for this article.
February 15, 2019: Anaesthesia
L A Hermez, C J Spence, M J Payton, S A R Nouraei, A Patel, T H Barnes
Clinical observations suggest that compared with standard apnoeic oxygenation, transnasal humidified rapid-insufflation ventilatory exchange using high-flow nasal oxygenation reduces the rate of carbon dioxide accumulation in patients who are anaesthetised and apnoeic. This suggests that active gas exchange takes place, but the mechanisms by which it may occur have not been described. We used three laboratory airway models to investigate mechanisms of carbon dioxide clearance in apnoeic patients. We determined flow patterns using particle image velocimetry in a two-dimensional model using particle-seeded fluorescent solution; visualised gas clearance in a three-dimensional printed trachea model in air; and measured intra-tracheal turbulence levels and carbon dioxide clearance rates using a three-dimensional printed model in air mounted on a lung simulator...
February 15, 2019: Anaesthesia
T Wojcikiewicz, K El-Boghdadly
No abstract text is available yet for this article.
February 12, 2019: Anaesthesia
S D Adhikary, W M Liu, E Fuller, H Cruz-Eng, K J Chin
Regional anaesthesia is often helpful in improving respiratory function and analgesia following multiple rib fractures. The erector spinae plane block has become the technique of choice in our institution due to its relative simplicity and purported safety. The aim of this retrospective cohort study was to determine its effectiveness in improving respiratory and analgesic outcomes. We reviewed electronic medical records of patients with traumatic rib fractures admitted to a level-one trauma centre between January 2016 and July 2017, who also received erector spinae plane blocks...
February 10, 2019: Anaesthesia
S R Wilson, S Shinde, I Appleby, M Boscoe, D Conway, C Dryden, K Ferguson, W Gedroyc, S M Kinsella, M H Nathanson, J Thorne, M White, E Wright
There has been an increase in the number of units providing anaesthesia for magnetic resonance imaging and the strength of magnetic resonance scanners, as well as the number of interventions and operations performed within the magnetic resonance environment. More devices and implants are now magnetic resonance imaging conditional, allowing scans to be undertaken in patients for whom this was previously not possible. There has also been a revision in terminology relating to magnetic resonance safety of devices...
February 3, 2019: Anaesthesia
J Womack, J D Pearson, I A Walker, N M Stephens, B A Goodman
Rib fractures are associated with significant morbidity and mortality. Ultrasound-guided thoracic paravertebral catheter insertion has been described for the management of pain secondary to rib fractures. We conducted a retrospective observational study of all patients with rib fractures who had a paravertebral catheter inserted for analgesia provision over a 4-year period. Data from the Trauma Audit and Research Network were used to compare patients with rib fractures who were managed with paravertebral catheters to those managed with systemic analgesia...
January 27, 2019: Anaesthesia
N A M Dekker, D Veerhoek, N J Koning, A L I van Leeuwen, P W G Elbers, C E van den Brom, A B A Vonk, C Boer
We investigated microcirculatory perfusion disturbances following cardiopulmonary bypass in the early postoperative period and whether the course of these disturbances mirrored restoration of endothelial glycocalyx integrity. We performed sublingual sidestream dark field imaging of the microcirculation during the first three postoperative days in patients who had undergone on-pump coronary artery bypass graft surgery. We calculated the perfused vessel density, proportion of perfused vessels and perfused boundary region...
January 27, 2019: Anaesthesia
A McGee, D Gardiner
No abstract text is available yet for this article.
January 23, 2019: Anaesthesia
C D Nawn, M B Blackburn, R A De Lorenzo, K L Ryan
Proper placement of the tracheal tube requires confirmation, and the predominant method in addition to clinical signs is the presence of end-tidal carbon dioxide. Such is the importance of confirmation that novel methods may also have a place. We previously demonstrated using ex-vivo swine tissue a unique spectral reflectance characteristic of tracheal tissue that differs from oesophageal tissue. We hypothesised that this characteristic would be present in living swine tissue and human cadavers. Reflectance spectra in the range 500-650 nm were captured using a customised fibreoptic probe, compact spectrometer and white light source from both the trachea and the oesophagus in anesthetised living swine and in human cadavers...
January 21, 2019: Anaesthesia
W Z A Zakhary, E W Turton, A Flo Forner, K von Aspern, M A Borger, J K Ender
We retrospectively compared patients receiving remifentanil with patients receiving sufentanil undergoing fast-track cardiac surgery. After 1:1 propensity score matching there were 609 patients in each group. The sufentanil group had a significantly longer mean (SD) ventilation time compared with the remifentanil group; 122 (59) vs. 80 (44) min, p < 0.001 and longer mean (SD) length of stay in the recovery area; 277 (77) vs. 263 (78) min, p = 0.002. The sufentanil group had a lower mean (SD) visual analogue pain score than the remifentanil group; 1...
January 20, 2019: Anaesthesia
W Shippam, R Preston, J Douglas, J Taylor, A Albert, A Chau
High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30-70 l.min-1 oxygen flow) via nasal prongs with standard 15 l.min-1 oxygen breathing via a tight-fitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min tidal volume breathing and 30s tidal breathing followed by eight vital capacity breaths...
January 20, 2019: Anaesthesia
S Vargas-Prada, E B Macdonald
No abstract text is available yet for this article.
January 18, 2019: Anaesthesia
P J Le Fevre, C Gough, B J Hearne, L Corbett, C Seller, T M Cook, F E Kelly
Conventional emergency front of neck airway training manikins mimic slim patients and are associated with unrealistic procedural ease. We have described previously a pork belly-modified manikin that more realistically simulated an obese patient's neck. In this study, we compared a novel obese-synthetic manikin (obese-synthetic manikin) with a pork belly-modified manikin (obese-meat manikin) and a conventional slim manikin (slim manikin). Thirty-three experienced anaesthetists undertook simulated emergency front of neck airway procedures on each manikin (total 99 procedures)...
January 17, 2019: Anaesthesia
D Mayhew, V Mendonca, B V S Murthy
The American Society of Anesthesiologists (ASA) physical status is a tool commonly used to classify a patient's physical fitness before surgery. Since its introduction in 1941 it has undergone very few modifications to improve its reliability and to eliminate subjectivity, despite vast changes in both surgical and anaesthetic technique. We present the history of the ASA physical status and review the literature on its applicability to contemporary anaesthetic practice.
January 15, 2019: Anaesthesia
S White, R Griffiths, M Baxter, T Beanland, J Cross, J Dhesi, A B Docherty, I Foo, G Jolly, J Jones, I K Moppett, E Plunkett, K Sachdev
Ageing populations have greater incidences of dementia. People with dementia present for emergency and, increasingly, elective surgery, but are poorly served by the lack of available guidance on their peri-operative management, particularly relating to pharmacological, medico-legal, environmental and attitudinal considerations. These guidelines seek to deliver such guidance, by providing information for peri-operative care providers about dementia pathophysiology, specific difficulties anaesthetising patients with dementia, medication interactions, organisational and medico-legal factors, pre-, intra- and postoperative care considerations, training, sources of further information and care quality improvement tools...
January 11, 2019: Anaesthesia
D A Scott, L A Evered
No abstract text is available yet for this article.
January 11, 2019: Anaesthesia
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