Anaesthesia
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An analysis of 1500 laryngeal mask airway uses by one anaesthetist using the standard insertion technique was conducted to determine successful insertion rates, position by fibreoptic larynoscopy, complication rates and whether there is a long-term learning curve. The correlation between laryngeal mask airway placement and modified Mallampati grade was also determined. The first time insertion rate was 95.5% with an overall failure rate after three attempts of 0.4%. ⋯ The vocal cords were visible from the mask aperture bars in 97.1%. Comparison of insertion rates, fibreoptic position and complications for the first and second 750 insertions provides evidence for a 'long' term learning curve. These data could be used as a guide for 'optimal' or expected successful laryngeal mask airway insertion rates in adults undergoing routine anaesthesia.
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Comparative Study
A practical evaluation of four human-powered portable airway aspirators.
The establishment of a clear airway is a vital part of basic life support and mechanical devices are available to assist the clearance of the upper airway during resuscitation. The performances of four human-powered devices, currently available in the United Kingdom, were compared with the relevant British Standard. The ease of use of the devices by 20 experienced and 20 novice resuscitators was assessed. ⋯ However, two devices ('Res-Q-Vac' and 'Ambu Maxi Suction Pump') were more user friendly. The incidence of airway contamination during resuscitation and the current recommended resuscitation protocols suggest that there is a need for increased emphasis on these airway adjuncts in life-support training. Wider access to basic life support equipment inside and outside hospital premises may improve resuscitation outcome.
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This study was undertaken to evaluate the effect of the levering laryngoscope on the view obtained at laryngoscopy. Two hundred and ten consecutive patients who required tracheal intubation were studied. The view at laryngoscopy with the levering laryngoscope blade in the neutral and elevated positions was recorded. ⋯ In patients where the view of the larynx was grade 1 or 2 with the blade in the neutral position, elevation of the levered tip often (23%) resulted in the view being impaired. This was not a clinical problem as the blade could simply be returned to the neutral position. The levering laryngoscope is a useful additional aid to laryngeal visualisation.