Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2010
Randomized Controlled TrialFentanyl dose for the insertion of Classic Laryngeal Mask Airways in non-paralysed patients induced with propofol 2.5 mg/kg.
The aim of this randomised, controlled trial was to determine the optimum dose of fentanyl in combination with propofol 2.5 mg x kg(-1) when inserting the Classic Laryngeal Mask Airway. Seventy-five ASA I or II patients were randomly assigned to five groups of fentanyl dosage: 0 microg x kg(-1) (placebo), 0.5 microg x kg(-1), 1.0 microg x kg(-1), 1.5 microg x kg(-1) and 2.0 microg x kg(-1). Anaesthesia was induced by first injecting the study drug over 10 seconds. ⋯ We found that there was a high rate of successful first attempt at insertion with 1 microg x kg(-1) and 1.5 microg x kg(-1), 93% and 87% respectively, compared to 87% in the 2.0 microg x kg(-1) group. The 1.0 microg x kg(-1) group also achieved an 80% optimal insertion conditions score of 4, compared to 73% in the 1.5 microg x kg(-1) group and 80% in the 2 microg x kg(-1) group. Therefore we recommend 1.0 microg x kg(-1) as the optimal dose of fentanyl when used in addition to propofol 2.5 mg/kg for the insertion of the Classic Laryngeal Mask Airway.
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Laryngeal mask airways (LMA) are commonly used in paediatric anaesthesia. A well-placed LMA should provide a direct view of the vocal cords facilitating bronchoscopy or fibreoptic intubation. The aim of this audit was to assess the bronchoscopic view of the glottis obtained through an LMA with regard to its size. ⋯ The epiglottis impinged on the LMA opening, partially obstructing the view of the glottis in 36.3% of size 1 LMAs, 31.5% of size 1.5, 21% of size 2 and 17.8% of size 2.5. In 13.7% of size 1 LMAs, 11% of size 1.5, 6.3% of size 2 and 4.4% of size 2.5, the epiglottis was completely downfolded, obstructing the view of the glottic aperture. The findings indicate that even if ventilation is judged as adequate, smaller paediatric LMAs are more commonly associated with suboptimal anatomical positioning with partial obstruction of the glottic aperture than larger LMAs, and therefore may require repositioning more often.
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Anaesth Intensive Care · Jan 2010
Comparative StudyIntubation through the LMA-Supreme: a pilot study of two techniques in a manikin.
The LMA-Supreme is a single-use disposable laryngeal mask that combines features of several laryngeal mask airways in one device. The primary aim of our study was to compare ease of use and operator preference for fibreoptic-aided intubation through the LMA-Supreme using an Aintree Intubating Catheter or Arndt Airway Exchange Catheter Set. Twenty participants experienced in fibreoptic-aided intubation performed a total of 40 intubations on an AirSim airway manikin through a #4 LMA-Supreme. ⋯ All 20 (100%) Arndt Airway Exchange Catheter Set-assisted intubations and 18/20 (90%) of Aintree Intubating Catheter-assisted intubations were successful. Aintree Intubating Catheter and Arndt Airway Exchange Catheter Set-assisted intubations can be performed quickly, successfully and with minimal difficulty through the LMA-Supreme by experienced operators. While the Arndt Airway Exchange Catheter may be easier the Aintree Intubating Catheter is faster.
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Anaesth Intensive Care · Jan 2010
Ocular surface bacterial colonisation in sedated intensive care unit patients.
We investigated the time-dependent ocular surface bacterial colonisation of sedated patients hospitalised in an intensive care unit and aimed to evaluate whether proper topical antibiotic prophylaxis could prohibit corneal infection. The study lasted 12 months and included 134 patients undergoing sedation and mechanical respiratory support for various medical reasons. Patients hospitalised for less than seven days and those with pre-existing ocular surface pathology were excluded. ⋯ Infectious keratitis was prohibited in all cases. Ocular surface of long-term sedated patients was found to be colonised by various bacterial species and their isolation was closely associated with the time period of hospitalisation. The results of this study suggest that the early identification of ocular surface bacteria colonisation and the administration of topical antibiotics for prophylaxis can prohibit corneal infection in these patients.
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Anaesth Intensive Care · Jan 2010
The effect of dexmedetomidine on agitation during weaning of mechanical ventilation in critically ill patients.
Ventilated patients receiving opioids and/or benzodiazepines are at high risk of developing agitation, particularly upon weaning towards extubation. This is often associated with an increased intubation time and length of stay in the intensive care unit and may cause long-term morbidity. Anxiety, fear and agitation are amongst the most common non-pulmonary causes of failure to liberate from mechanical ventilation. ⋯ Excluding unrelated clinical deterioration, 22 episodes (73.3%) achieved successful weaning from ventilation with a median (interquartile range) ventilation time of 70 (28 to 96) hours after dexmedetomidine infusion. Dexmedetomidine achieved rapid resolution of agitation and facilitated ventilatory weaning after failure of conventional therapy. Its role as first-line therapy in ventilated, agitated patients warrants further investigation.