Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Complications associated with removal of the laryngeal mask airway: a comparison of removal in deeply anaesthetised versus awake patients.
The purpose of the study was to compare the incidence of complications (coughing, biting, retching, vomiting, excessive salivation and airway obstruction) associated with removal of the laryngeal mask airway. The laryngeal mask airway was used in 100 adults undergoing urological procedures. The patients were randomly assigned to two groups. ⋯ No decrease in arterial oxygenation occurred in the anaesthetised patients in whom the laryngeal mask was removed by the anaesthetist. In 14 patients in the awake group the pH of secretions at the tip of the laryngeal mask was < or = 3 compared with only four patients in the anaesthetised group (P < 0.05). It is concluded that it may be safer to remove the laryngeal mask airway whilst the patients are deeply anaesthetised in the operating room than when they are awake in the recovery room.
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Successful tracheal intubation with Augustine Guide (Augustine Medical, Inc., Eden Prairie, MN) in patients with normal airways has recently been described. There are no studies describing Augustine Guide (AG) use in patients with difficult airways. Accordingly, we studied AG intubation in a population of patients with expected difficult airways due to cervical spine pathology, limited mouth opening, obesity, facial trauma or deformity due to previous operation or radiation and in patients with unexpectedly difficult airways. ⋯ Using the AG, all were intubated successfully (36/44 at the first attempt, in 8/44 repositioning of the AG to allow successful laryngeal entry of the stylet was necessary). There were no failures or complications secondary to AG use. This study shows that the AG is a useful device for oral tracheal intubation in patients with known or unexpectedly difficult airways.
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We describe the use of a laryngeal mask airway in three adult patients whose mouth opening varied from 12 mm to 18 mm. The first patient's incisal opening was 12 mm. His airway was otherwise normal and the standard laryngeal mask was used as the definitive airway for the 90 min revision of facial scars and bone graft to mandible. ⋯ The third patient, in addition to a mouth opening of only 18 mm, had limited neck movement from previous flap reconstruction following mandibulectomy, hemiglossectomy and radical neck dissection. For three more reconstructive head and neck procedures that ranged from 90 min to nine hours, the flexible reinforced laryngeal mask was inserted under topical anaesthesia and its correct position confirmed by fibreoptic laryngoscopy before induction of general anaesthesia. Maintenance of anaesthesia in all cases was uneventful and there were no postoperative complications.
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The authors report the successful treatment of post-dural puncture headache, consequent to a cervical dural puncture, with a lumbar extradural blood patch. The increase in intracranial pressure generated by the injection of autologous blood in the extradural space seems to be the likely mechanism for the prompt relief of post-dural puncture headache. We conclude that extradural injection of autologous blood at the same level of the dural puncture may not be necessary.