Journal of anesthesia
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Journal of anesthesia · Aug 2012
Randomized Controlled TrialParker Flex-Tip Tube® provides higher intubation success with the Pentax-AWS Airwayscope® despite the AWS tip being inserted into the vallecula.
The Parker Flex-Tip(®) tube, in combination with the Pentax-Airwayscope(®) (AWS), is anecdotally reported to facilitate intubation when the AWS tip fails to be inserted behind the epiglottis. We examined whether the Parker tube facilitates intubation when the AWS tip is inserted into the vallecula. Forty patients were randomly assigned into either the standard or Parker tube group. ⋯ The primary outcome was defined as the success rate for intubation and secondary outcome as the time needed for tube placement. The Parker tube provided both a higher intubation success rate (17/20 vs. 4/20, P < 0.01), and a faster intubation time (17 ± 5 s vs. 25 ± 4 s, P < 0.01), than the standard tube. We conclude the use of the Parker tube in combination with the AWS is an optional technique allowing the laryngoscopist to obtain more reliable intubation success despite insertion of the AWS tip into the vallecula.
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Journal of anesthesia · Aug 2012
Use of dexmedetomidine for the treatment of alcohol withdrawal syndrome in critically ill patients: a retrospective case series.
Alcohol withdrawal syndrome (AWS) continues to be a challenge to manage in the ICU setting, and the ideal pharmacological treatment continues to evolve. Dexmedetomidine is a newer agent approved for short-term sedation in the ICU, but its use in the treatment of AWS has been limited. We report a retrospective case series of ten patients who were identified as receiving dexmedetomidine for AWS as designated by electronic pharmacy records. ⋯ Dexmedetomidine was safe to use in all patients, although mechanical ventilation was still required in three patients. With dexmedetomidine, the autonomic hyperactivity was blunted, with a mean 12.8% reduction in rate pressure product observed. Consideration should be given to the combined use of dexmedetomidine with benzodiazepines in the treatment of AWS.
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Journal of anesthesia · Aug 2012
Comparative StudyThe learning curve for laryngoscopy: Airtraq versus Macintosh laryngoscopes.
Airtraq use by inexperienced personnel has been evaluated in simulator studies, but little is known about the learning process in real patients. This prospective study was designed to compare learning curves for laryngoscopy with the Airtraq or Macintosh laryngoscopes in patients under general anesthesia. ⋯ Students achieved higher success rates using the Airtraq laryngoscope during early training on live patients. The Airtraq may be a useful choice for teaching advanced airway management, especially to professionals who will not perform laryngoscopy on a regular basis.
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Journal of anesthesia · Aug 2012
Calcium channel blockers are inadequate for malignant hyperthermia crisis.
Malignant hyperthermia (MH) results from disordered calcium (Ca(2+)) homeostasis in skeletal muscle during general anesthesia. Although Ca(2+) channel blockers may be given to treat the tachycardia and circulatory instability, coadministration of Ca(2+) channel blockers and dantrolene is contraindicated during MH crisis. We evaluated the effect of Ca(2+) channel blockers on Ca(2+) homeostasis and their interactions with dantrolene in human skeletal muscle. ⋯ Ca(2+) channel blockers led to increased [Ca(2+)](i) in human skeletal muscle cells. The increase is thus scarcely affected by dantrolene treatment. Data provide a greater physiologic basis for avoiding the use of Ca(2+) channel blockers during MH crisis.
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Journal of anesthesia · Aug 2012
Effects of tidal volume and PEEP on arterial blood gases and pulmonary mechanics during one-lung ventilation.
The main problem of one-lung ventilation (OLV) is hypoxemia. The use of a high tidal volume for preventing hypoxemia during OLV is controversial. We compared the effects of a high tidal volume versus a low tidal volume with or without PEEP on arterial oxygen tension (PaO(2)) and pulmonary mechanics during OLV. ⋯ During OLV, mechanical ventilation with a low tidal volume with or without PEEP increased hypoxemia as compared to that when performing OLV with a high tidal volume.