BACKGROUND Continuous positive airways pressure (CPAP) with a CPAP machine and mask has been shown to be more effective at minimising hypoxaemia than other devices under deep sedation. However, the efficacy of a new and simple CPAP device for spontaneously breathing obese patients during colonoscopy is unknown. OBJECTIVE We hypothesised that oxygenation and ventilation in obese patients under deep sedation during colonoscopy using CPAP via a new nasal mask (SuperNO(2)VA) would be better than routine care with oxygen supplementation via a nasal cannula. DESIGN Randomised study. SETTING Single-centre, June 2017 to October 2017. PATIENTS A total of 174 patients were enrolled and randomly assigned to Mask group or Control group. Thirty-eight patients were excluded and data from 136 patients underwent final analysis. INTERVENTION Patients in the Mask group were provided with nasal CPAP (10 cmH(2)O) at an oxygen flow rate of 15 l min(-1). In the Control group, patients were given oxygen via a nasal cannula at a flow rate of 5 l min(-1). MAIN OUTCOME MEASURES The primary outcome was elapsed time from anaesthesia induction to the first airway intervention. RESULTS The elapsed time from anaesthesia induction to the first airway intervention was 19 +/- 10 min in the Mask group (n=63) vs. 10 +/- 12 min in the Control group (n=73, P < 0.001). In all, 87.5% (56/64) of patients achieved the target CPAP value. More patients in the Control group (63%) received airway intervention than in the Mask group (22%) (P < 0.001). Hypoxaemia (pulse oximeter oxygen saturation, SpO(2) < 90%) occurred more frequently in the Control group (22%) than in the Mask group (5%) (P = 0.004). Minute ventilation(Postinduction)/minute ventilation(Baseline) and minute ventilation(Procedure-end)/minute ventilation(Baseline) was lower in the Control group than in the Mask group (P = 0.007 and 0.001, respectively). CONCLUSION Application of a nasal mask at a target CPAP of 10 cmH(2)O improves ventilation and decreases the frequency and severity of hypoxaemia.
BACKGROUND Perception of halitosis in patients during intubation is a common and additional stressor for anaesthesiologists and may lead to potential health risks. OBJECTIVES We hypothesised that intubation with videolaryngoscopy could help reduce the anaesthesiologists' perception of patients' oral malodor during intubation. DESIGN A single-blinded, randomised controlled trial. SETTING Single centre general hospital, Guangdong Province, China. PARTICIPANTS A total of 440 patients who underwent intubation under general anaesthesia for elective surgery, aged 18 to 60 years old, American Society of Anaesthesiologists class I to III, without upper airway abnormality or airway infection were enrolled. INTERVENTION Patients were randomly assigned to receive either UE videolaryngoscopy (UE) or Macintosh's direct laryngoscopy (Macintosh) group. All intubations were performed by one of six very experienced anaesthesiologists. MAIN OUTCOME MEASURES The patient's oral odour score was measured prior to induction of anaesthesia. The anaesthesiologists' perception of the patient's oral malodor during intubation was recorded. The shortest distance from patient's mouth to the anaesthesiologist's nose (MN distance), the exertion rating and discomfort were also measured. RESULTS The oral malodor score did not differ in the UE and Macintosh groups prior to the induction of anaesthesia. However, the incidence of the anaesthesiologists' perception of halitosis during intubation was significantly lower in the UE group compared with the Macintosh group (P<0.001). Similarly, the MN distance was significantly greater in the UE group compared with the Macintosh group (P< 0.001). The first-attempt success rate was higher in the UE group compared to the Macintosh group (P< 0.001). However, the exertion scores were considerably higher in the Macintosh group. After intubation, anaesthesiologists experienced more waist and shoulder discomfort with the Macintosh than the UE technique of intubation. CONCLUSION Compared with direct laryngoscopy, videolaryngoscopy might reduce the anaesthesiologists' perception of the patients' oral malodor, help improve first-attempt success rate, as well as alleviate the anaesthesiologists' waist and shoulder discomfort.
BACKGROUND Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression. OBJECTIVE To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression. DESIGN This was a multicentre, prospective, longitudinal study. SETTING The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017. PATIENTS Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled. MAIN OUTCOME MEASURE Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model. RESULTS Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023). CONCLUSION For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.
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BACKGROUND Multimodal analgesia can improve postoperative pain and possibly accelerate functional recovery after surgery. Serratus plane block (SPB) is a novel, ultrasound-guided regional anaesthetic technique for complete analgesia of the anterolateral chest wall. But, the effect of SPB on the quality of recovery after breast cancer surgery has not been established. OBJECTIVE To test the hypothesis that pre-operative SPB would enhance the quality of recovery following breast cancer surgery. DESIGN A randomised, double-blind, parallel-group, placebo-controlled trial. SETTING Single university teaching hospital, from March 2016 to June 2017. PATIENTS Seventy-two women scheduled for breast cancer surgery. INTERVENTION Participants were randomised in a 1 : 1 ratio to receive SPB with 25 ml of ropivacaine 0.5% or physiological saline. MAIN OUTCOME MEASURES The primary endpoint was the 40-item Quality of Recovery questionnaire score 24 hours postoperatively hours. Secondary endpoints were postoperative pain intensity, cumulative opioid consumption, postoperative nausea and vomiting, dizziness, post anaesthesia care unit discharge time and patient satisfaction. RESULTS The global median [IQR] 40-item Quality of Recovery questionnaire score at 24 postoperative hours was significantly higher in the SPB group (158 [153.8 to 159.3]) than the control group (141 [139 to 145.3]) with a median difference of 15 (95% confidence interval: 13 to 17, P<0.001). Compared with the control group, postoperative pain scores at rest were significantly lower up to 24 h in the SPB group. Pre-operative SPB reduced postoperative cumulative opioid consumption, the incidence of postoperative nausea and vomiting and the post anaesthesia care unit discharge time. In addition, patient satisfaction scores were higher in the SPB group. CONCLUSION Pre-operative administration of SPB with ropivacaine improved the quality of recovery, postoperative analgesia and patient satisfaction following breast cancer surgery.
BACKGROUNDDexmedetomidine (DEX) has been used for sedation in young infants and children undergoing transthoracic echocardiography (TTE). The median effective dose of intranasal DEX has not been described for postcardiac surgery children. Postcardiac surgery children could require more DEX to achieve satisfactory sedation for TTE examination than children suspected of congenital heart disease.OBJECTIVESTo study whether postcardiac surgery children need a larger dose of DEX for TTE than normal children.DESIGNA double-blind sequential allocation trial with doses determined by the Dixon and Massey up-and-down method.SETTINGA tertiary care teaching hospital from 25 October to 30 November 2016.PATIENTSChildren under the age of 3 years requiring intranasal DEX for TTE.INTERVENTIONSChildren were allocated to a postcardiac surgery group (n=20) or a normal group (n=19). The first patient in both groups received intranasal DEX (2g kg(-1)): using the up-and-down method of Dixon and Massey, the next dose was dependent on the previous patient's response.MAIN OUTCOME MEASURESMedian effective dose was estimated from the up-and-down method of Dixon and Massey and probit regression. A second objective was to study haemodynamic stability and adverse events with these doses.RESULTSThe median effective dose (95% confidence interval) of intranasal DEX was higher in postcardiac surgery children than in normal children, 3.3 (2.72 to 3.78) g kg(-1) versus 1.8 (1.71 to 2.04) (g kg(-1)), respectively (P<0.05). There were no significant differences in time to sedation, time to wake-up or TTE examination time between the two groups for successful sedation. Additionally, there were no significant adverse events.CONCLUSIONThe median effective dose of intranasal DEX for TTE sedation in postcardiac surgery children was higher than in normal children.TRIAL REGISTRATIONchictr.org.cn identifier: ChiCTR-OOC-16009846.
BACKGROUND The use of sedation is becoming more commonplace. Although pulse oximetry is a standard monitoring procedure during sedation, it cannot accurately detect early hypoventilation. End-tidal carbon dioxide (EtCO2) monitoring can be an earlier indicator of airway compromise; however, the existing literature is limited to a few studies with varying outcomes. OBJECTIVES To evaluate whether EtCO2 monitoring decreases the incidences of CO2 retention and apnoeic events in propofol-based sedation. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Two hundred women (aged 18 to 65 years, ASA physical status 1 or 2) who were scheduled for breast lumpectomy between June 2017 and August 2017. INTERVENTIONS Patients were allocated randomly to receive either standard monitoring or standard monitoring and EtCO2 monitoring. MAIN OUTCOME MEASURES The primary outcome was the incidence of CO2 retention. The secondary outcomes were the number of actions taken to restore ventilation, variations in PaCO2 and pH, the frequency of apnoea and the recovery time. RESULTS CO2 retention occurred significantly less often in the EtCO2 monitoring group (10 vs. 87%; P < 0.0001). In the standard monitoring group, the mean PaCO2 was more than 6 kPa (45 mmHg) and the pH was less than 7.35 at 5, 10, 20 and 30 min after induction of anaesthesia and at the end of the procedure. Both values were within the normal range in the EtCO2 monitoring group. The number of airway interventions performed was significantly higher in the EtCO2 monitoring group (9.8 +/- 1.8 vs. 1.9 +/- 1.0; P < 0.0001). Apnoea occurred significantly less often in the EtCO2 monitoring group (0 vs. 10%; P < 0.0001) and recovery time was shorter (9.9 +/- 1.4 vs. 11.4 +/- 2.1 min; P = 0.048). CONCLUSION The addition of EtCO2 monitoring to standard monitoring during propofol-based sedation can improve patient safety by decreasing the incidence of CO2 retention, and therefore the risk of hypoxaemia through early recognition of apnoea, and can also shorten recovery time. TRIAL REGISTRATION This trial is registered with (ChiCTR-INR-17011537).
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BACKGROUNDPostoperative supraventricular arrhythmias are common in patients after thoracoscopic lobectomy. Inadequate pain control has long been recognised as a significant risk factor for arrhythmias. The performance of ultrasound-guided (USG) thoracic paravertebral block (PVB) is increasing as an ideal technique for postoperative analgesia.OBJECTIVEWe conducted this study to evaluate whether a single-shot USG thoracic PVB would result in fewer postoperative supraventricular tachycardias (SVT) than intercostal nerve blocks (ICNBs) after thoracoscopic pulmonary resection.DESIGNA randomised controlled study.SETTINGA single university hospital.PATIENTSSixty-eight patients undergoing thoracoscopic lobectomy were randomised into two equal groups of 34.INTERVENTIONSFor postoperative pain control, all patients received a total of 0.3mlkg(-1) of a mixture containing 0.5% ropivacaine and 1/200000 epinephrine after placement of needles for either a single thoracic PVB or two individual ICNBs, both guided by ultrasound. Data were obtained during the first 48 postoperative hours.MAIN OUTCOME MEASURESThe primary outcome was the incidence of SVT after thoracoscopic pulmonary resection.RESULTSDuring the first 48 postoperative hours, the incidences of SVT and atrial fibrillation were lower in the USG thoracic PVB group (14.7 vs. 46.9%, P=0.004 and 3.0 vs. 18.8%, P=0.037, respectively). The requirement for -receptor blockade was more frequent in the ICNBs group than in the PVB group (5.9 vs. 25%, P=0.033).CONCLUSIONAfter placement of the needle using ultrasound guidance, a single-shot thoracic PVB is a well tolerated and effective technique to reduce the incidences of postoperative SVT and atrial fibrillation in patients undergoing thoracoscopic pulmonary resection.TRIAL REGISTRATIONhttp://www.chictr.org/cn/, registration number: ChiCTR-IOR-17010952.