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Background: The utility of positive pressure ventilation with the laryngeal mask airway (LMA™) in children was described previously, but the possibility of gastric insufflation, related to high peak airway pressure, continues to be a disadvantage. In this prospective study, inspiratory pressures, air leak and signs of gastric insufflation were compared between volume‐controlled ventilation (VCV) and pressure‐controlled ventilation (PCV) using an LMA.

Background: This prospective randomized study was designed to evaluate the effects of adding remifentanil to the standard propofol‐based technique in the setting of paediatric haematology‐oncology outpatient clinic.

Esmolol, a short-acting beta 1-antagonist, can reduce anaesthetic requirements and decrease seizure activity during electroconvulsive therapy even after a single dose of 80 mg. We studied the effect of esmolol on the bispectral index scale (BIS), which is a processed EEG recently introduced to monitor depth of anaesthesia.

Protective gear is mandatory for medical personnel treating casualties in a contaminated environment. In the present study, we assessed the ability of emergency medical technicians to insert an intravenous line in this situation. Sixty emergency medical technicians were randomized to a control group, wearing fatigues, and a study group, wearing full protective gear. The ability to insert an intravenous line in healthy volunteers was assessed 1, 2, 4, and 8 hours after randomization. We found no effect of protective gear (p = 0.543) or time in protective gear (p = 0.8869) on success rate or on time needed for successful task completion (p = 0.4005 and p = 0.9021, respectively). The overall success rate was 58.6%, 65% in the unprotected state and 56% in the protected state, and the time was 303 +/- 115 and 351 +/- 113 seconds, respectively. These findings suggest that introduction of an intravenous line is possible but time consuming even after a prolonged stay in full protective gear. Alternative methods for antidotal treatment, such as the use of automatic autoinjectors for intramuscular administration, might be suggested.

Abstract: Objective: To evaluate the pharmacokinetic parameters of morphine and lidocaine after a single intravenous dose in critically ill patients. Design: Prospective, clinical study. Setting: General intensive care unit (ICU) in a university hospital. Patients: Patients admitted to the ICU with severe systemic inflammatory response syndrome of various etiologies. Interventions: A single intravenous dose of morphine (0.025 mg/kg) and lidocaine (1.5 mg/kg) were given separately 12–36 h after admission, and arterial blood samples for serum drug levels were taken. Measurements and results: Morphine pharmacokinetics were studied in 30 patients. The clearance (Cl) was found to be 5.7 � 2.3 ml/kg per min, volume of distribution of the central compartment (Vc) 0.16 � 0.12 l/kg and volume of distribution at steady state (Vss) 1.08 � 0.69 l/kg. These values are lower then those described previously for healthy volunteers (33.5 � 9 ml/kg per min, 1.01 � 0.31 l/kg, and 5.16 � 1.4 l/kg, respectively), and similar to those described in trauma and burned patients. Lidocaine pharmacokinetics were tested in 24 subjects. The Cl was 6.9 � 3.8 ml/kg per min, Vc 0.25 � 0.1 l/kg and Vss 0.78 � 0.26 l/kg. These values are not different from parameters published previously for healthy volunteers (10 ml/kg per min, 0.53 l/min and 1.32 l/min, respectively). No correlation was found between clinical variables and pharmacokinetic parameters of both drugs (ANOVA). Conclusions: Both morphine and lidocaine have a reduced volume of distribution in critically ill patients. The normal lidocaine clearance indicates preserved hepatic blood flow and suggests that other mechanisms are involved in the reduced morphine clearance. These findings may have application for the treatment of ICU patients.

Background. Prediction of the response of the left ventricular stroke volume to fluid administration remains an unsolved clinical problem. We compared the predictive performance of various haemodynamic parameters in the perioperative period in patients undergoing coronary artery bypass surgery. These parameters included static indicators of cardiac preload and functional parameters, derived from the arterial pressure waveform analysis. These included the systolic pressure variation (SPV) and its delta down component (dDown), pulse pressure variation (PPV), stroke volume variation (SVV), and a new parameter, termed the respiratory systolic variation test (RSVT), which is a measure of the slope of the lowest systolic pressure values during a standardized manoeuvre consisting of three successive incremental pressure-controlled breaths. Methods. Eighteen patients were included into this prospective observational study. Seventy volume loading steps (VLS), each consisting of 250 ml of colloid administration were performed before surgery and after the closure of the chest. The response to each VLS was considered as a positive (increase in stroke volume more than 15%) or non-response. Receiver operating characteristic curves were plotted for each parameter to evaluate its predictive value. Results. All functional parameters predicted fluid responsiveness better than the intrathoracic blood volume and the left ventricular end-diastolic area. Parameters with the best predictive ability were the RSVT and PPV. Conclusions. Functional haemodynamic parameters are superior to static indicators of cardiac preload in predicting the response to fluid administration. The RSVT and PPV were the most accurate predictors of fluid responsiveness, although only the RSVT is independent of the settings of mechanical ventilation.

Background. Similarly to systolic pressure variation (SPV), pulse pressure variation (PPV) and stroke volume variation (SVV) derived from arterial pulse contour analysis have been shown to reflect fluid responsiveness in ventilated patients. However, unlike the SPV, both PPV and SVV have not been validated during extreme hypovolaemia. The aim of the present study was to examine whether these newly introduced variables respond to gradual hypovolaemia like the SPV by increasing gradually with each step of the haemorrhage even during extreme hypovolaemia. Methods. SPV, SVV and PPV were measured in 8 dogs following initial volume loading (10% of the estimated blood volume administered as colloid solution), 5 steps of graded haemorrhage, each consisting of 10% of the estimated blood volume, followed by retransfusion of the shed blood. Results. The correlations of the SVV, SPV and PPV to the stroke volume (SV) throughout the study were −0.89, −0.91 and −0.91, respectively. Correlations of the CVP and the global end-diastolic volume (GEDV) of the heart chambers to the SV were 0.79 and 0.95, respectively. The SPV correlated significantly with both the PPV and the SVV (r=0.97 and 0.93 respectively). However, the PPV increased by more than 400% at 50% haemorrhage compared with increases of 200% and 120% for the SVV and %SPV, respectively. Conclusion. This study demonstrates that the present algorithm used for the calculation of the SVV and the formula used to calculate the PPV, perform well over a wide range of preload states including severe hypovolaemia. However, the PPV changes more than the SPV and SVV. This may be due to the changing relation of the SV to the pulse pressure when the filling of the aorta is greatly decreased.

Introduction: Although sedation is critical in minimizing discomforts in patients, conflicting data regarding the safety of sedation among the elderly population exist. This prospective study aimed to compare the quality of recovery (QoR) from gastrointestinal endoscopy performed under sedation between elderly and younger patients., Methods: We included 177 patients aged 40-64 (group 1, n = 66), 65-79 (group 2, n = 76), and ≥80 (group 3, n = 35) years. QoR was assessed 1 day after the procedure using the quality of recovery 15 (QoR-15) questionnaire, which is a 15-item questionnaire with scores ranging from 0 to 150. Patient demographic, procedural, and sedation data were collected, and neurocognitive function was assessed before and a day after sedation., Results: Groups 1 and 3 differed according to the Mini-Cog test and 3-word memory test performed before the procedure (p < 0.001). QoR-15 scores between groups were not different (139 ± 19 group 1, 141 ± 17 group 2, and 147 ± 26 group 3; p > 0.05). Patients in groups 3 and 2 were administered lower doses of propofol and midazolam than those in group 1. The incidence of oxygen desaturation (SaO2 <90% for >30 s) was lower in groups 1 and 2 than in group 3 (p = 0.01)., Conclusions: As indicated by the QoR-15 questionnaire, the QoR from sedation was not significantly different between the study groups., (© 2024 The Author(s). Published by S. Karger AG, Basel.)