Journal of clinical anesthesia
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Comparative Study
Comparison of a new visual stylet (Discopo)-guided laryngeal mask airway placement vs conventional blind technique: a prospective randomized study.
To compare the ease of laryngeal mask airway (LMA) insertion and fiberoptic view of LMA after placement using the Discopo visual stylet-guided insertion and conventional blind technique. ⋯ By direct visualizing the whole process of LMA insertion, the Discopo visual stylet increases the success rate and accuracy rate of LMA placement without increasing hemodynamic stress response or incidences of adverse events.
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Review
Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities.
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures. cPNB has also been associated with a reduction in time to discharge readiness compared with sPNB. ⋯ Potential infectious complications of catheters, although rare, include local inflammation and infection. Other considerations for ambulatory cPNB include appropriate patient selection, education, and need for 24/7 availability of a health care provider to address any complications. The ideal PNB technique would have a duration of action that is sufficiently long to address the most intense period of postsurgical pain; should be associated with minimal risk of infection, neurologic complications, bleeding, and local anesthetic systemic toxicity; and should be easy to perform, convenient for patients, and easy to manage in the postoperative period.
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Observational Study
Confirmation of optimal guidewire length for central venous catheter placement using transesophageal echocardiography.
Several authors have reported rare, but severe, complications associated with the length of the intravascular guidewire during central venous catheter placement, as the wire tip can cause cardiac arrhythmia or perforation or become trapped within the vessel. Although one report investigated the optimal guidewire length using fluoroscopy, few reports have precisely measured guidewire position using transesophageal echocardiography (TEE). Here, we investigated the appropriate intravascular length of a guidewire for right internal jugular vein approach using TEE during cardiac surgery. ⋯ We confirmed the wire tips at all cases by ultrasonography. The distance using TEE was similar to that by fluoroscopy, but TEE was more precise. Guidewire length was weakly correlated to height. About 15 cm as minimum length should be considered the limit for guidewire length in an adult, in consideration of height, to ensure patient safety during central catheter placement for right internal jugular vein approach.
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Randomized Controlled Trial Comparative Study
A comparison of King Vision video laryngoscopy and direct laryngoscopy as performed by residents: a randomized controlled trial.
For more than 40 years, direct laryngoscopy (DL) has been used to assure the airway during endotracheal intubation. The King Vision video laryngoscope is one of the latest devices introduced for endotracheal intubation. We hypothesize that, relative to direct laryngoscopy, it improves the intubation success rate with fewer intubation attempts and no difference in intubation time or complications. ⋯ The use of KVVL by residents with less than 1 year of training (considered nonexperts) significantly improves visualization of the glottis in patients without predictors of difficult airway. The incidence of complications was too low to draw conclusions.
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Multicenter Study Comparative Study
Variability in anesthesiologists' approach to the preoperative management of asthmatic children.
No consensus guidelines exist for the preoperative treatment of asthmatic children referred for elective surgery. We investigated the attitude of pediatric anesthesiologists to this issue. ⋯ A wide variability exists in pediatric anesthesiologists' approach to the preoperative management of asthmatic children for most common case scenarios. This is probably explained by the heterogeneity of asthma, the type of surgery, the lack of guidelines, and the paucity of data. Similarities as well as differences exist between pediatric anesthesiologists and pulmonologists. Further studies and implementation of consensus guidelines are needed.