Computerised dynamic posturography to assess recovery comparing general anaesthesia with sedation and local anaesthesia for day case nasal surgery

Abstract

SummaryWe performed a national postal survey exploring anaesthetists' practice in rapid sequence induction. All respondents used pre-oxygenation, although the technique employed, and its reliability, varied. Thiopental and succinylcholine, given after waiting for signs of loss of consciousness, were the most widely used drugs for rapid sequence induction. Propofol and rocuronium were used by more than a third of respondents, and most respondents (75%) also routinely administered an opioid. Cricoid pressure was used universally but the practice of its application varied widely. The commonest aids used if intubation was difficult were the gum elastic bougie, the long laryngoscope blade and the laryngeal mask. After failed intubation, approximately half of respondents would maintain the supine position. Failure to intubate at rapid sequence intubation had been seen by 45% of respondents but harm was uncommon. In contrast, 28% had seen regurgitation, which frequently led to considerable harm and to three deaths. In spite of this, practice of a failed intubation drill was uncommon (15%) and anaesthetic assistants were rarely known to practice application of cricoid pressure. Consultants were less likely than trainees to use rocuronium as a muscle relaxant, and more likely to choose morphine if administering an opioid. They were less likely to practice a failed intubation drill. Other aspects of practice varied little between grades. This survey suggests that many anaesthetists do not follow best practice when performing a rapid sequence induction.

Study on the usefulness of precise and simple dynamic balance tests for the evaluation of recovery from intravenous sedation with midazolam and propofol

“…The recovery of dynamic balance function assessed by CDP after the injection of midazolam for intravenous sedation has been reported [5,[9][10][11], but no studies on propofol sedation have been reported. We confirmed that propofol is more suitable than midazolam for intravenous sedation in the outpatient clinic with regard to street fitness using precise and simple dynamic balance tests in the present study.…”

“…We previously reported that the intentional body sway test was useful for the evaluation of recovery from intravenous sedation in the elderly, but was not suitable for young adults [11]. CDP is classified according to the types of postural control as CDP using an intentional postural sway task [11,18,19] and CDP using perturbation stimuli [5,9,10]. As falls may occur in any direction in daily life, multidirectional mechanical perturbation is a desirable stimulus condition for CDP [20].…”