Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2006
Comparative StudyCraniocervical extension improves the specificity and predictive value of the Mallampati airway evaluation.
The modified Mallampati (MMP) classification is a standard airway examination that assesses mouth opening and structures within the oral cavity. Recent data suggest that maximal mouth opening (as measured by interdental distance) is possible only with extension of the craniocervical junction. Because the MMP examination is performed with the head in a neutral position, the airway may appear worse because of submaximal interdental distance. We hypothesized that adding craniocervical extension to the MMP would allow for greater mouth opening, lower scores, and less false positives than the traditional MMP examination. ⋯ Craniocervical extension improves the specificity and positive predictive value of the MMP airway evaluation while retaining sensitivity of the traditional MMP examination. The introduction of the EMS into clinical practice should be considered.
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Anesthesia and analgesia · Nov 2006
Comparative StudyTrends in gender distribution among anesthesiology residents: do they matter?
The number of women graduating from United States medical schools progressively increased during the 26 yr period from 1978 to 2004. This change was associated with shifts in the gender distribution of residents training in Accreditation Council for Graduate Medical Education-accredited residency programs. ⋯ The reasons for this distribution are multifactorial. Contributing factors may include limited exposure to women role models (including fewer women with senior academic rank and in leadership positions), gender insensitivity leading to an unprofessional work environment, limited involvement of women anesthesiologists in undergraduate medical education, misperceptions of the physician-patient relationship in anesthesiology, and practice scheduling requirements that are inconsistent and inflexible.
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Anesthesia and analgesia · Nov 2006
Pediatric airway and esophageal profiles with acoustic reflectometry.
Acoustic reflectometry is a technique by which the dimensions of a cavity can be estimated in the form of an area-distance profile. We conducted a pilot study to obtain the acoustic reflectometry (AR) images associated with breathing tube (endotracheal tube, ETT) placement (inner diameter 4.5-6 mm) and positioning in 21 (n = 21) children, aged 2-12 yr. Characteristic AR profiles, as previously noted in adults, were obtained for tracheal and esophageal intubations in children. ⋯ Relative to a tracheal profile, a bronchial intubation exhibits a decrease in area distal to the carina position. With deeper ETT insertion, abutment of the ETT against the bronchial wall can occur, with a possible profound area decrease. The occurrence of ETT abutment in children and neonates, and its possible AR detection and treatment, is discussed.
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Anesthesia and analgesia · Nov 2006
Comment Letter Comparative StudyLaryngeal exposure using the flexiblade laryngoscope.