The haemodynamic changes of the prone position were investigated in 40 ASA I–II patients undergoi... more The haemodynamic changes of the prone position were investigated in 40 ASA I–II patients undergoing lumbar spine surgery. Patients were randomly assigned, following propofol intravenous induction, to receive maintenance of anaesthesia using either isoflurane 1–1.2 % in air or target controlled propofol 3 lg.ml)1 infusion. Measurements of non-invasive blood pressure, heart rate and cardiac output were made in the supine position. The patient was then turned prone onto a Montreal pattern mattress and measurements repeated. Cardiac output measurements were made using a non-invasive cardiac output monitor. We found a significant reduction in cardiac index in both groups and a significantly greater change with propofol compared to isoflurane on turning supine to prone (CI change 0.4 vs 0.7 l.min)1.m)2 p = 0.001 and SVRI change 89 vs 177 dyne.s)1.cm)5, p = 0.041). We conclude that turning healthy patients prone produces a clinically significant reduction in cardiac output, the change bein...
The European Diploma in Anaesthesiology and Intensive Care (EDAIC) examination is a multilingual,... more The European Diploma in Anaesthesiology and Intensive Care (EDAIC) examination is a multilingual, end-of-training (Part II), two-part examination covering the relevant basic sciences and clinical subjects appropriate for a specialist anaesthesiologist. This examination is accredited by the European Board of Anaesthesiology, part of the Union of European Medical Specialties (UEMS) and is extremely valuable in the settings of the expanding European Union. Numerous countries have already adopted EDAIC as their national exam. Its uniqueness comes from the diversity of languages and the multitude of host centres, mostly European, making it more approachable. The article focuses on the development of EDAIC, the structure of the different parts of the exam, offering valuable tips to future candidates. It also contains important information regarding accreditation of anaesthetic centres of excellence and the fellowship programme offered by the European Society of Anaesthesiology (ESA).
Background. Traditionally it has been accepted that the patient’s face should be at the level bet... more Background. Traditionally it has been accepted that the patient’s face should be at the level between xiphisternum and umbilicus of the anaesthetist during intubation. However we noticed wide variation in the adoption of this guidance. We could not find any studies looking at the effect of the height of the trolley on the technique of laryngoscopy. We decided to evaluate the effect of trolley height on the time taken, success rate, posture adopted and perception of difficulty in placement of a tracheal tube introducer in the trachea of a manikin set to simulate difficult intubating conditions. Methods. Forty eight anaesthetists were invited to participate in a randomised crossover manikin study, designed to evaluate the effect of the trolley height on the speed and success rate of tracheal tube introducer placement. The manikin, set to simulate difficult airway, was placed on a trolley adjusted to represent four trolley heights as determined by the level of the manikin’s face in rel...
International Journal of Obstetric Anesthesia, 2002
Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean se... more Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean section under epidural anaesthesia using 0.5% bupivacaine alone.t Expectations for pain-free surgery are high, leading to patient dissatisfaction and consequent medicolegal implications. The addition of epidural opioid improves the quality of epidural anaesthesia, yet up to 42% of women require additional intraoperative analgesia. 2 Intravenous remifentanil has been widely used in awake patients to supplement regional anaesthesia. 3 A low-dose remifentanil infusion may reduce discomfort during epidural caesarean section without causing significant adverse effects to mother or baby.
Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a haz... more Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a hazard, with the potential to cause total spinal anaesthesia and maternal collapse. Sacral block appears early after intrathecal injections compared with epidural ones, and we therefore used SI motor block to determine a safe and reliable test dose for epidural catheter misplacement. Mothers booked for elective Caesarean section were given various intrathecal doses of bupivacaine with fentanyl during routine combined spinal-epidural anaesthesia. Using sequential allocation we found that the ED50 for SI motor block 10 min after intrathecal injection was bupivacaine 7 mg with fentanyl 14 micrograms (95% CI, 6.2-7.8 mg). We then used intrathecal bupivacaine 13 mg to look for the ED95. We found the calculated ED97.5 to be bupivacaine 9.7 mg with fentanyl 19.4 micrograms (95% CI, 8.7-11.4). We conclude that testing for SI motor block 10 min after epidural injection of bupivacaine 10 mg is a reli...
Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated eithe... more Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated either to the full left lateral position (n = 45) or to the supine position with 12 degrees left lateral tilt (n = 42) after a combined spinal-epidural (CSE) in the sitting position and an initial 2 min in the full right lateral position. Fewer mothers were hypotensive while in the study position [29 (64%) in lateral group vs. 38 (90%) in the tilted supine group; p = 0.03]. Mothers in the lateral group tended to become hypotensive after turning them back to the tilted supine position immediately before surgery; hence the number of mothers who were hypotensive from the insertion of the CSE until delivery were similar [36 (80%) vs. 38 (90%)]. Mothers in the lateral group needed a lower dose of ephedrine to treat their hypotension while in their study position (median (interquartile range [range]) 6 (0-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg, respectively; p = 0.04) but ephedrine requirements were similar overall (12 (6-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg), respectively. The full left lateral position reduces the incidence of early hypotension compared with the tilted supine position with tilt, and makes it easier to treat.
International Journal of Obstetric Anesthesia, 2002
Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean se... more Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean section under epidural anaesthesia using 0.5% bupivacaine alone.t Expectations for pain-free surgery are high, leading to patient dissatisfaction and consequent medicolegal implications. The addition of epidural opioid improves the quality of epidural anaesthesia, yet up to 42% of women require additional intraoperative analgesia. 2 Intravenous remifentanil has been widely used in awake patients to supplement regional anaesthesia. 3 A low-dose remifentanil infusion may reduce discomfort during epidural caesarean section without causing significant adverse effects to mother or baby.
Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a haz... more Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a hazard, with the potential to cause total spinal anaesthesia and maternal collapse. Sacral block appears early after intrathecal injections compared with epidural ones, and we therefore used SI motor block to determine a safe and reliable test dose for epidural catheter misplacement. Mothers booked for elective Caesarean section were given various intrathecal doses of bupivacaine with fentanyl during routine combined spinal-epidural anaesthesia. Using sequential allocation we found that the ED50 for SI motor block 10 min after intrathecal injection was bupivacaine 7 mg with fentanyl 14 micrograms (95% CI, 6.2-7.8 mg). We then used intrathecal bupivacaine 13 mg to look for the ED95. We found the calculated ED97.5 to be bupivacaine 9.7 mg with fentanyl 19.4 micrograms (95% CI, 8.7-11.4). We conclude that testing for SI motor block 10 min after epidural injection of bupivacaine 10 mg is a reliable test to detect accidental intrathecal injection in the obstetric population.
Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated eithe... more Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated either to the full left lateral position (n = 45) or to the supine position with 12 degrees left lateral tilt (n = 42) after a combined spinal-epidural (CSE) in the sitting position and an initial 2 min in the full right lateral position. Fewer mothers were hypotensive while in the study position [29 (64%) in lateral group vs. 38 (90%) in the tilted supine group; p = 0.03]. Mothers in the lateral group tended to become hypotensive after turning them back to the tilted supine position immediately before surgery; hence the number of mothers who were hypotensive from the insertion of the CSE until delivery were similar [36 (80%) vs. 38 (90%)]. Mothers in the lateral group needed a lower dose of ephedrine to treat their hypotension while in their study position (median (interquartile range [range]) 6 (0-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg, respectively; p = 0.04) but ephedrine requirements were similar overall (12 (6-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg), respectively. The full left lateral position reduces the incidence of early hypotension compared with the tilted supine position with tilt, and makes it easier to treat.
The haemodynamic changes of the prone position were investigated in 40 ASA I-II patients undergoi... more The haemodynamic changes of the prone position were investigated in 40 ASA I-II patients undergoing lumbar spine surgery. Patients were randomly assigned, following propofol intravenous induction, to receive maintenance of anaesthesia using either isoflurane 1-1.2% in air or target controlled propofol 3 microg.ml(-1) infusion. Measurements of non-invasive blood pressure, heart rate and cardiac output were made in the supine position. The patient was then turned prone onto a Montreal pattern mattress and measurements repeated. Cardiac output measurements were made using a non-invasive cardiac output monitor. We found a significant reduction in cardiac index in both groups and a significantly greater change with propofol compared to isoflurane on turning supine to prone (CI change 0.4 vs 0.7 l.min(-1).m(-2) p = 0.001 and SVRI change 89 vs 177 dyne.s(-1).cm(-5), p = 0.041). We conclude that turning healthy patients prone produces a clinically significant reduction in cardiac output, the change being greater during maintenance of anaesthesia using propofol compared to isoflurane.
The haemodynamic changes of the prone position were investigated in 40 ASA I–II patients undergoi... more The haemodynamic changes of the prone position were investigated in 40 ASA I–II patients undergoing lumbar spine surgery. Patients were randomly assigned, following propofol intravenous induction, to receive maintenance of anaesthesia using either isoflurane 1–1.2 % in air or target controlled propofol 3 lg.ml)1 infusion. Measurements of non-invasive blood pressure, heart rate and cardiac output were made in the supine position. The patient was then turned prone onto a Montreal pattern mattress and measurements repeated. Cardiac output measurements were made using a non-invasive cardiac output monitor. We found a significant reduction in cardiac index in both groups and a significantly greater change with propofol compared to isoflurane on turning supine to prone (CI change 0.4 vs 0.7 l.min)1.m)2 p = 0.001 and SVRI change 89 vs 177 dyne.s)1.cm)5, p = 0.041). We conclude that turning healthy patients prone produces a clinically significant reduction in cardiac output, the change bein...
The European Diploma in Anaesthesiology and Intensive Care (EDAIC) examination is a multilingual,... more The European Diploma in Anaesthesiology and Intensive Care (EDAIC) examination is a multilingual, end-of-training (Part II), two-part examination covering the relevant basic sciences and clinical subjects appropriate for a specialist anaesthesiologist. This examination is accredited by the European Board of Anaesthesiology, part of the Union of European Medical Specialties (UEMS) and is extremely valuable in the settings of the expanding European Union. Numerous countries have already adopted EDAIC as their national exam. Its uniqueness comes from the diversity of languages and the multitude of host centres, mostly European, making it more approachable. The article focuses on the development of EDAIC, the structure of the different parts of the exam, offering valuable tips to future candidates. It also contains important information regarding accreditation of anaesthetic centres of excellence and the fellowship programme offered by the European Society of Anaesthesiology (ESA).
Background. Traditionally it has been accepted that the patient’s face should be at the level bet... more Background. Traditionally it has been accepted that the patient’s face should be at the level between xiphisternum and umbilicus of the anaesthetist during intubation. However we noticed wide variation in the adoption of this guidance. We could not find any studies looking at the effect of the height of the trolley on the technique of laryngoscopy. We decided to evaluate the effect of trolley height on the time taken, success rate, posture adopted and perception of difficulty in placement of a tracheal tube introducer in the trachea of a manikin set to simulate difficult intubating conditions. Methods. Forty eight anaesthetists were invited to participate in a randomised crossover manikin study, designed to evaluate the effect of the trolley height on the speed and success rate of tracheal tube introducer placement. The manikin, set to simulate difficult airway, was placed on a trolley adjusted to represent four trolley heights as determined by the level of the manikin’s face in rel...
International Journal of Obstetric Anesthesia, 2002
Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean se... more Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean section under epidural anaesthesia using 0.5% bupivacaine alone.t Expectations for pain-free surgery are high, leading to patient dissatisfaction and consequent medicolegal implications. The addition of epidural opioid improves the quality of epidural anaesthesia, yet up to 42% of women require additional intraoperative analgesia. 2 Intravenous remifentanil has been widely used in awake patients to supplement regional anaesthesia. 3 A low-dose remifentanil infusion may reduce discomfort during epidural caesarean section without causing significant adverse effects to mother or baby.
Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a haz... more Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a hazard, with the potential to cause total spinal anaesthesia and maternal collapse. Sacral block appears early after intrathecal injections compared with epidural ones, and we therefore used SI motor block to determine a safe and reliable test dose for epidural catheter misplacement. Mothers booked for elective Caesarean section were given various intrathecal doses of bupivacaine with fentanyl during routine combined spinal-epidural anaesthesia. Using sequential allocation we found that the ED50 for SI motor block 10 min after intrathecal injection was bupivacaine 7 mg with fentanyl 14 micrograms (95% CI, 6.2-7.8 mg). We then used intrathecal bupivacaine 13 mg to look for the ED95. We found the calculated ED97.5 to be bupivacaine 9.7 mg with fentanyl 19.4 micrograms (95% CI, 8.7-11.4). We conclude that testing for SI motor block 10 min after epidural injection of bupivacaine 10 mg is a reli...
Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated eithe... more Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated either to the full left lateral position (n = 45) or to the supine position with 12 degrees left lateral tilt (n = 42) after a combined spinal-epidural (CSE) in the sitting position and an initial 2 min in the full right lateral position. Fewer mothers were hypotensive while in the study position [29 (64%) in lateral group vs. 38 (90%) in the tilted supine group; p = 0.03]. Mothers in the lateral group tended to become hypotensive after turning them back to the tilted supine position immediately before surgery; hence the number of mothers who were hypotensive from the insertion of the CSE until delivery were similar [36 (80%) vs. 38 (90%)]. Mothers in the lateral group needed a lower dose of ephedrine to treat their hypotension while in their study position (median (interquartile range [range]) 6 (0-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg, respectively; p = 0.04) but ephedrine requirements were similar overall (12 (6-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg), respectively. The full left lateral position reduces the incidence of early hypotension compared with the tilted supine position with tilt, and makes it easier to treat.
International Journal of Obstetric Anesthesia, 2002
Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean se... more Introduction: A degree of intraoperative pain occurs in up to 50% of patients during caesarean section under epidural anaesthesia using 0.5% bupivacaine alone.t Expectations for pain-free surgery are high, leading to patient dissatisfaction and consequent medicolegal implications. The addition of epidural opioid improves the quality of epidural anaesthesia, yet up to 42% of women require additional intraoperative analgesia. 2 Intravenous remifentanil has been widely used in awake patients to supplement regional anaesthesia. 3 A low-dose remifentanil infusion may reduce discomfort during epidural caesarean section without causing significant adverse effects to mother or baby.
Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a haz... more Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a hazard, with the potential to cause total spinal anaesthesia and maternal collapse. Sacral block appears early after intrathecal injections compared with epidural ones, and we therefore used SI motor block to determine a safe and reliable test dose for epidural catheter misplacement. Mothers booked for elective Caesarean section were given various intrathecal doses of bupivacaine with fentanyl during routine combined spinal-epidural anaesthesia. Using sequential allocation we found that the ED50 for SI motor block 10 min after intrathecal injection was bupivacaine 7 mg with fentanyl 14 micrograms (95% CI, 6.2-7.8 mg). We then used intrathecal bupivacaine 13 mg to look for the ED95. We found the calculated ED97.5 to be bupivacaine 9.7 mg with fentanyl 19.4 micrograms (95% CI, 8.7-11.4). We conclude that testing for SI motor block 10 min after epidural injection of bupivacaine 10 mg is a reliable test to detect accidental intrathecal injection in the obstetric population.
Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated eithe... more Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated either to the full left lateral position (n = 45) or to the supine position with 12 degrees left lateral tilt (n = 42) after a combined spinal-epidural (CSE) in the sitting position and an initial 2 min in the full right lateral position. Fewer mothers were hypotensive while in the study position [29 (64%) in lateral group vs. 38 (90%) in the tilted supine group; p = 0.03]. Mothers in the lateral group tended to become hypotensive after turning them back to the tilted supine position immediately before surgery; hence the number of mothers who were hypotensive from the insertion of the CSE until delivery were similar [36 (80%) vs. 38 (90%)]. Mothers in the lateral group needed a lower dose of ephedrine to treat their hypotension while in their study position (median (interquartile range [range]) 6 (0-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg, respectively; p = 0.04) but ephedrine requirements were similar overall (12 (6-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg), respectively. The full left lateral position reduces the incidence of early hypotension compared with the tilted supine position with tilt, and makes it easier to treat.
The haemodynamic changes of the prone position were investigated in 40 ASA I-II patients undergoi... more The haemodynamic changes of the prone position were investigated in 40 ASA I-II patients undergoing lumbar spine surgery. Patients were randomly assigned, following propofol intravenous induction, to receive maintenance of anaesthesia using either isoflurane 1-1.2% in air or target controlled propofol 3 microg.ml(-1) infusion. Measurements of non-invasive blood pressure, heart rate and cardiac output were made in the supine position. The patient was then turned prone onto a Montreal pattern mattress and measurements repeated. Cardiac output measurements were made using a non-invasive cardiac output monitor. We found a significant reduction in cardiac index in both groups and a significantly greater change with propofol compared to isoflurane on turning supine to prone (CI change 0.4 vs 0.7 l.min(-1).m(-2) p = 0.001 and SVRI change 89 vs 177 dyne.s(-1).cm(-5), p = 0.041). We conclude that turning healthy patients prone produces a clinically significant reduction in cardiac output, the change being greater during maintenance of anaesthesia using propofol compared to isoflurane.
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