Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Clinical Trial
Lightwand intubation: II--Clinical trial of a new lightwand for tracheal intubation in patients with difficult airways.
Lightwands have been used to assist in the tracheal intubation of patients with difficult airways for many years. A new lightwand (Trachlight) with a brighter light source and a flexible stylet permits both oral and nasal intubation under ambient light. This study reports the effectiveness of the Trachlight in tracheal intubation in patients with difficult airways. ⋯ The tracheas of these two patients were intubated successfully using a fibreoptic bronchoscope. Orotracheal intubation was successful in all patients in Group 2 using the Trachlight with a mean (+/- SD) time-to-intubation of 19.7 +/- 13.5 sec. Apart from minor mucosal bleeding (mostly from nasal intubation), no serious complications were observed in any of the study patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Tracheal intubation under direct vision using a laryngoscope can be challenging and difficult even in experienced hands. Transillumination of the soft tissues of the neck using a lighted-stylet (lightwand) is one of many effective alternative intubating techniques developed during the past several decades. While many versions of lightwand have been available, each has its limitations. ⋯ It is a light-guided technique in which there is no direct visualization of the upper airway structures. It should be avoided in patients with known anatomical abnormalities of the upper airway and used with caution in patients in whom transillumination of the anterior neck may not be achieved adequately. As with any intubating technique, successful intubation using the Trachlight relies on the preparation of the patient and the operator's skill and experience.
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Case Reports
Tracheal rupture following blunt chest trauma presenting as endotracheal tube obstruction.
In this report, we describe a patient in whom a tracheal tear followed blunt thoracic trauma. The diagnosis was made late resulting in problems with ventilation, endotracheal tube obstruction and cardiac arrest. ⋯ A review of airway management has been made as it requires combined anaesthetic and surgical expertise. Injuries of the trachea may have severe, life-threatening consequences and early diagnosis and management reduce morbidity and mortality.
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The effects of positive end-expiratory pressure (PEEP) and lung compliance (CL) on delivered tidal volume (VTdel) and ventilator output were evaluated in the following anaesthesia machine/ventilator systems: Narkomed III with a Model AV-E ventilator (III/AV-E system) and an Ohmeda Modulus II with either a 7810 anaesthesia ventilator (II/7810 system) or a Model 7000 anaesthesia ventilator (II/7000 system). With a standard circle anaesthesia breathing circuit connected to a test lung simulating CL, gas flow was measured and integrated over time at each combination of VT settings (VTset), 500 ml or 1000 ml; CL settings, 0.15 to 0.01 L.cm H2O-1 decreased incrementally; and PEEP settings, 0 to 30 cm H2O increased in 5-cm H2O increments. ⋯ As CL decreased to 0.01 L.cm H2O-1 and PEEP increased to 30 cm H2O, at VTset of 500 ml and 1000 ml, respective VTdel decreased linearly to 251 +/- 6 ml and 542 +/- 7 with the III/AV-E, 201 +/- 5 and 439 +/- 5, with the II/7810, and 181 +/- 4 and 433 +/- 7 ml with the II/7000 (P < 0.05 among the three systems). Loss in VTdel due to PEEP alone, which increased only slightly when VTset was increased, accounted for an increasingly greater percentage of VTset as it was decreased, which was less pronounced with low CL.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of 26-gauge Atraucan and 25-gauge Whitacre needles: insertion characteristics and complications.
Ninety-six women undergoing post-partum tubal ligation under spinal anaesthesia were studied to compare 26G Atraucan with 25G Whitacre spinal needles for ease of insertion, number of attempts at needle insertion, cerebrospinal fluid (CSF) flow characteristics through the needles, quality of subsequent analgesia, and incidence of perioperative complications. A higher rate of successful dural puncture at the first attempt (40/50 vs 27/46, P < 0.05) and faster (mean +/- SD, 11.5 +/- 2.2 vs 13.5 +/- 2.4, P < 0.001) CSF flow through the needle was achieved with the Atraucan than with the Whitacre needle. The incidence of failed spinal (4% vs 5%) and post-dural puncture headache (PDPH) (4% vs 4.3%) was similar with both needles, but more patients experienced paraesthesiae during needle insertion with the Whitacre than with the Atraucan needle (15% vs 2%, P < 0.05). We conclude that the use of the 26G Atraucan needle is associated with a higher rate of successful identification of the subarachnoid space at the first attempt, faster CSF backflow, and fewer paraesthesia when compared with the 25G Whitacre needle.