Abstract:
BACKGROUND:Short-axis ultrasound-guided placement of central venous catheters (CVCs) is widely accepted as safe practice. However, utilizing the long-axis approach could further improve safety, as it allows for better visualization of the needle as it is advanced to the target vessel. However, the long-axis approach has not widely been used due to the technical difficulty. Recently, a new needle guidance device has become available to aid in the long-axis approach. We hypothesized that the use of a needle guide paired with the long-axis approach would facilitate puncture of the target vessel in a simulation model more effectively than similar free-hand techniques. METHODS:A prospective observational study of anaesthesia residents using a CVC partial-task training device was conducted. Each resident performed needle puncture of the target vessel with three different techniques, assigned in random order: short-axis free hand (S-FH), long-axis free hand (L-FH), and long-axis needle guide (NG). To prove the effectiveness of the needle guide, the fraction of time the needle tip remained in view of the ultrasound was recorded and compared. Time required for completing the task and the number of needle sticks and needle re-directions were compared. RESULTS:Thirty-three residents participated in the study. The fraction of time the needle tip remained in view of the ultrasound was significantly higher for the residents using NG [0.90 (0.10)] compared with residents using the other techniques [L-FH: 0.36 (0.20), S-FH: 0.18 (0.10)] (P<0.001). For each resident, the use of the needle guide in the long-axis approach increased visualization by 352 (276)% compared with that of L-FH and by 1028 (1804) % compared with that of S-FH. There was no significant difference in time required to puncture the target between NG [23.7 (14.6) s] and L-FH [30.3 (36.5) s] (P=0.21); however, both were significantly longer than S-FH [17.0 (13.3) s] (P=0.012). The numbers of needle sticks and of needle re-directions did not differ among the groups. CONCLUSIONS:The needle guide device used in the long-axis approach improved the needle visualization compared with free-hand techniques. The needle guide used in the long-axis technique, however, did not facilitate puncture of the target vessel in this simulation model when compared with free-hand techniques.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Ball RD,Scouras NE,Orebaugh S,Wilde J,Sakai Tdoi
10.1093/bja/aer329subject
Has Abstractpub_date
2012-01-01 00:00:00pages
72-9issue
1eissn
0007-0912issn
1471-6771pii
S0007-0912(17)32517-5journal_volume
108pub_type
杂志文章,随机对照试验abstract::We evaluated prospectively the use of Gram staining of protected pulmonary specimens to allow the early diagnosis of ventilator-associated pneumonia (VAP), compared with the use of 60 bronchoscopic protected specimen brushes (PSB) and 126 blinded plugged telescopic catheters (PTC) obtained from 134 patients. Gram stai...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/85.5.735
更新日期:2000-11-01 00:00:00
abstract::We studied 34 patients undergoing elective repair of an abdominal aortic aneurysm under combined general anaesthesia and epidural block to evaluate the acute effects of diaspirin crosslinked haemoglobin (DCLHb) 50, 100 and 200 mg kg-1 i.v. Haemodynamic variables were measured continuously using pulmonary and radial ar...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/83.5.702
更新日期:1999-11-01 00:00:00
abstract::We tested the hypothesis that pressures exerted on the pharyngeal mucosa by the laryngeal mask airway (LMA) and cuffed oropharyngeal airway (COPA) differ, in 20 male and 20 female adult patients. Microchip pressure sensors were attached to the LMA and COPA at four similar anatomical locations (base of the tongue, late...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/82.6.922
更新日期:1999-06-01 00:00:00
abstract::A method for the assessment and management of factors both causing and maintaining a primary metabolic alkalosis is presented. During a 2-year period 65 patients with metabolic alkalosis were treated with saline and potassium chloride infusions. In four patients the alkalosis was refractory and required additional the...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/49.8.811
更新日期:1977-08-01 00:00:00
abstract:BACKGROUND:The efficacy of opioids typically decreases after long-term use owing to the development of tolerance. Glial activation and the upregulation of proinflammatory cytokines are related to the induction of tolerance. We investigated the effect of leukemia inhibitory factor (LIF) on morphine analgesia and toleran...
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doi:10.1093/bja/aew247
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abstract::Fentanyl or alfentanil, in doses approximating to those used in clinical practice, was added to the priming fluid of an extracorporeal circuit before the institution of cardiopulmonary bypass (CPB). The concentrations of both drugs in the priming fluid were measured over a 20-min period. The concentration of fentanyl ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/58.9.947
更新日期:1986-09-01 00:00:00
abstract::One explanation for diminished opioid analgesic efficacy is opioid-induced hyperalgesia (OIH). We report a case of OIH in an infant with gastroschisis, requiring multiple surgical interventions and prolonged sedation for ventilation. This is the first report of OIH in an infant. On day 41 of life after nine separate s...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aer332
更新日期:2012-01-01 00:00:00
abstract::We studied two groups of six patients scheduled for gastrointestinal surgery; they were allocated randomly to receive high- or low-dose fentanyl anaesthesia. The confounding effect of protein balance, before the trauma of surgery, on postoperative nitrogen excretion was controlled by standardized protein intake before...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1994-06-01 00:00:00
abstract::Plasma concentrations of pancuronium were measured using a fluorimetric method in six patients with normal renal function and seven patients in chronic renal failure. A tow-compartment open model was used in the pharmacokinetic analysis of the data. With this model, the clearance of pancuronium was found to be reduce...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.4.341
更新日期:1976-04-01 00:00:00
abstract::The pharmacokinetics of edrophonium were determined in patients anaesthetized with nitrous oxide and halothane undergoing kidney transplant nephrectomy (n=6) or transplantation of a live related donor kidney (n = 6). Serum concentrations of edrophonium were assayed by high pressure liquid chromatography and pharmacoki...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.12.1311
更新日期:1981-12-01 00:00:00
abstract:BACKGROUND:There is growing interest in the effect of postoperative analgesics on oncological outcomes after cancer surgery. We investigated the impact of tramadol after breast cancer surgery on recurrence and mortality and explored the mechanism by which tramadol affects cultured breast cancer cells in vitro. METHODS...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2019.09.004
更新日期:2019-12-01 00:00:00
abstract::Percutaneous dilatational tracheostomy (PDT) is associated with a number of life-threatening complications. We present a case of massive and fatal arterial haemorrhage that occurred in the intensive care unit during an elective PDT on an 86-year-old woman following earlier evacuation of a traumatic subdural haematoma....
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeg074
更新日期:2003-04-01 00:00:00
abstract::The relative sensitivity of sympathetic preganglionic and postganglionic axons, B and C fibres, respectively, to two structurally dissimilar local anaesthetics was examined. The concentration of amethocaine (ester-linked tertiary amine) or prilocaine (amide-linked secondary amine) required to reduce the B fibre compou...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/47.11.1135
更新日期:1975-11-01 00:00:00
abstract::We have studied the tone of the lower oesophageal sphincter (LOS) in 40 adults undergoing routine body surface surgery and allocated randomly to receive anaesthesia either by face mask and Guedel airway or by laryngeal mask airway. In the laryngeal mask group there was a mean (SEM) decrease in barrier pressure (LOS mi...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to pr...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2018.10.066
更新日期:2019-08-01 00:00:00
abstract::We studied the size 4 laryngeal mask airway (LMA) to test the hypothesis that oropharyngeal leak pressure and fibreoptic position improves with increasing cuff volume. After LMA insertion, 50 anaesthetized adult patients had the cuff inflated in 5-ml increments to 40 ml. Oropharyngeal leak pressure was optimal at 15 m...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/81.2.186
更新日期:1998-08-01 00:00:00
abstract::We have examined the effects of bupivacaine and lignocaine on myocardial metabolism in the rat isolated heart-lung preparation. Bupivacaine 1, 5 or 25 micrograms ml-1 or lignocaine 4, 20 or 100 micrograms ml-1 was administered 5 min after the start of perfusion. Both bupivacaine 25 micrograms ml-1 and lignocaine 100 m...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/65.4.521
更新日期:1990-10-01 00:00:00
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journal_title:British journal of anaesthesia
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doi:10.1093/bja/aeq414
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abstract::We present a new pattern of nerve stimulation--double burst stimulation (DBS)--to detect residual neuromuscular block manually. The DBS consists of two short lasting, 50-Hz tetanic stimuli or bursts separated by a 750-ms interval. The response to this pattern of stimulation is two single separated muscle contractions ...
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abstract:BACKGROUND:Opioids can increase sensitivity to noxious stimuli and cause opioid-induced hyperalgesia. We performed a systematic review to evaluate the clinical consequences of intra-operative doses of opioid. METHODS:We identified randomized controlled trials which compared intra-operative opioid to lower doses or pla...
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pub_type: 杂志文章,meta分析,评审
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abstract::We have examined the role of gamma-aminobutyric acid (GABA) neurones in propofol anaesthesia in mice using the righting reflex. Propofol i.p. increased the percentage of loss of the righting reflex in a dose-dependent manner with an ED50 value of 140 (95% confidence limits 123-160) mg kg-1 (n = 40; eight animals per d...
journal_title:British journal of anaesthesia
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abstract:BACKGROUND:The effect of anaesthetic drugs on long-term oncological outcomes after cancer surgery is an area of current interest. Dexamethasone is widely used in anaesthetic practice; however, its effect on long-term survival and cancer outcomes is not known. This study presents the results of a 5-yr follow-up of patie...
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pub_type: 杂志文章,随机对照试验
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abstract::To determine if improved postoperative recovery in surgical inpatients receiving intraoperative therapeutic suggestions are applicable in an outpatient population, 70 consenting, unpremedicated adults undergoing elective outpatient hernia repair under general anaesthesia were allocated randomly to either a therapeutic...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1999-06-01 00:00:00
abstract::As the route of breathing and use of airway apparatus such as mask, mouthpiece and noseclip can alter breathing pattern, this study has used the helium dilution method to estimate the effects of mouthpiece and mask breathing on functional residual capacity (FRC) in the supine position, and the change in FRC that occur...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1996-04-01 00:00:00
abstract::We have examined the effects of sedation with midazolam 0.1 mg kg-1 and reversal with flumazenil 0.5 mg on beat-to-beat heart rate (HR) variability (HRV), systolic arterial pressure (SAP), finger photoplethysmograph amplitude (PLA) and impedence pneumography in eight volunteers. With the onset of sedation there was a ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
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更新日期:1996-04-01 00:00:00
abstract:Background:The influence of different head and neck positions on the effectiveness of ventilation with the air-Q® self-pressurizing airway remains unevaluated. This study aimed to evaluate the influence of different head and neck positions on ventilation with the air-Q® SP airway. Methods:In this prospective, randomiz...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
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更新日期:2017-03-01 00:00:00
abstract::We studied 40 elderly patients undergoing cataract surgery. Ten non-insulin-dependent diabetes mellitus (NIDDM) patients received standardized general anaesthesia, 10 NIDDM patients received local anaesthesia using retrobulbar block, 10 non-diabetic control patients received general anaesthesia and 10 non-diabetic con...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/74.5.500
更新日期:1995-05-01 00:00:00
abstract::Seventeen patients received morphine 0.2 mgkg-1 in a 10% dextrose solution i.m. (n = 5), extradurally (n = 6) and intrathecally (n = 6) for pain after operation. Morphine was measured in plasma by radioimmunoassay. Plasma immunoreactive morphine concentration was significantly less after intrathecal administration aft...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.9.911
更新日期:1981-09-01 00:00:00
abstract::Three anaesthetic techniques based on isoflurane were compared in outpatients undergoing laparoscopy. Sixty healthy patients were randomly allocated to receive isoflurane via mask (spontaneous respiration), via tracheal tube (spontaneous respiration) or via tracheal tube with controlled ventilation. Moderate hypercarb...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/59.2.189
更新日期:1987-02-01 00:00:00