Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2017
Randomized Controlled Trial Comparative StudyAmbu® AuraGain™ versus LMA Supreme™ Second Seal™: a randomised controlled trial comparing oropharyngeal leak pressures and gastric drain functionality in spontaneously breathing patients.
Newer second generation supraglottic airway devices may perform differently in vivo due to material and design modifications. We compared performance characteristics of the Ambu® AuraGain™ and LMA Supreme™ Second Seal™ in 100 spontaneously breathing anaesthetised patients in this randomised controlled study. We studied oropharyngeal leak pressures (OLP) (primary outcome) and secondarily, ease of insertion, success rates, haemodynamic response, time to insertion, and complications of usage. ⋯ One AuraGain and six LMA Supremes failed to be placed within the stipulated 120 seconds trial definition of 'success'; these patients had risk factors for failed supraglottic insertion. In conclusion, both devices had similar OLPs and performed satisfactorily. However, the AuraGain resulted in less postoperative sore throat despite being harder to and taking longer to, insert.
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Anaesth Intensive Care · Mar 2017
Randomized Controlled TrialValidation of a difficult endotracheal intubation simulator designed for use in anaesthesia training.
There is a need for a validated endotracheal intubation trainer that has variable difficulty settings for the training and assessment of medical practitioners. In this study three anatomical modifications were retrofitted to a commercial manikin and then validated. These modifications included restricted movements of the mandible as well as changes to the upper incisors. ⋯ The time for the novice and intermediate groups improved significantly by the fourth attempt, novice 15 seconds (CI 5.4, 24.6, P=0.002) and intermediate 10 seconds (CI 1.0, 19.0, P=0.03). Other aspects of validity were also satisfied during this study. A high degree of validity was established for these modifications, which can be retrofitted to an existing manikin and then used for teaching or assessment.
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Anaesth Intensive Care · Nov 2016
Randomized Controlled TrialDriving impairment due to propofol at effect-site concentrations relevant after short propofol-only sedation.
Australian guidelines state "Following brief surgery or procedures with short acting anaesthetic drugs, the patient may be fit to drive after a normal night's sleep. After long surgery or procedures requiring longer lasting anaesthesia, it may not be safe to drive for 24 hours or more". The increasing use of the short-acting anaesthetic drug propofol as a solitary sedative medication for simple endoscopy procedures suggests a need to review this blanket policy. ⋯ Driving impairment at 0.2 µg/ml propofol effect-site concentration was not statistically different to placebo. Impairment increased with propofol effect-site concentration (P=0.002) and at 0.4 µg/ml it was similar to that found with a blood alcohol concentration of 50 mg/100 ml (0.05%). Plasma propofol concentrations of 0.2 µg/ml, as might be found approximately an hour after short (<1 hour duration) propofol-only sedation for endoscopy, were not associated with driving impairment in our young cohort of volunteers.
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Anaesth Intensive Care · Sep 2016
Randomized Controlled TrialOptimal flexible laryngeal mask airway size in children weighing 10 to 20 kg.
This prospective, randomised study was conducted to assess the effect of flexible laryngeal mask airway (FLMA) size on oropharyngeal leak pressure (OLP) in children at the recommended intracuff pressure. A total of 120 children undergoing elective ophthalmic surgery were randomly assigned to the size 2 FLMA group or size 2.5 FLMA group. The primary measurement was OLP at an intracuff pressure of 40 cmH2O. ⋯ In subgroup analyses based on weight, the size 2.5 FLMA had a lower occurrence of OLP <10 cmH2O and insufficient ventilation (27% versus 0, P=0.0046) in children 16-20 kg. We conclude that at a 40 cmH2O intracuff pressure, the OLP with the size 2 and size 2.5 FLMA was similar in children weighing 10-15.9 kg. However, in children weighing 16-20 kg, size 2 devices had a higher incidence of low OLP and insufficient ventilation, so a 2.5 FLMA may be preferable in this subgroup.
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Anaesth Intensive Care · Mar 2016
Randomized Controlled Trial Comparative StudyEnd-tidal sevoflurane concentration for ProSeal(TM) versus Classic(TM) laryngeal mask airway insertion in unpremedicated anaesthetised adult females.
The optimal end-tidal sevoflurane concentration for successful ProSealTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (PLMA) versus ClassicTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (CLMA) insertion in unpremedicated anaesthetised adults is unknown. We determined end-tidal sevoflurane concentrations for successful insertion in fifty percent of anaesthetised adults. This randomised, prospective, double-blind study was conducted in the operating theatre of a government tertiary care hospital. ⋯ The end-tidal sevoflurane concentration required for successful LMA insertion in fifty percent of anaesthetised adults was calculated as the mean of the crossover pairs' midpoints in each group and further confirmed by probit regression analysis. The end-tidal sevoflurane concentration (95% confidence interval) required for successful PLMA insertion in 50% of anaesthetised adults (3.15% [3.12% to 3.18%]) was significantly higher than that for CLMA insertion (2.71% [2.66% to 2.76%], P<0.001). These findings suggest that deeper anaesthesia is required for placement of a PLMA in comparison to a CLMA.