Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effects of single-handed and bimanual cricoid pressure on the view at laryngoscopy.
The effects of two different methods of cricoid pressure on laryngoscopic view were studied in 94 healthy women presenting for routine gynaecological surgery. Laryngoscopy was performed with either single-handed or bimanual cricoid pressure; after grading of the view obtained, the other method was used and second grading performed. Laryngoscopic view was better with the bimanual than with the single-handed technique (p = 0.016). ⋯ Age, weight, Mallampatti score and thyromental distance did not differ between patients in these three groups. Bimanual cricoid pressure should be the initial technique of choice during rapid sequence induction but, in a minority of cases, switching to a single-handed technique may improve the laryngoscopic view. The technique of cricoid pressure which produces the best laryngoscopic view in an individual patient cannot be predicted from the physical features studied.
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Guidelines for cardiac anaesthesia could reduce irrational variation in practice and so improve cardiac surgical outcome. In October 1994, a postal survey was undertaken to determine the views and attitudes of consultant cardiac anaesthetists in the United Kingdom towards guidelines. ⋯ Responses to other parts of the questionnaire showed that those against guidelines for cardiac anaesthesia were less positive towards their advantages and more negative to their disadvantages compared with those in their favour. The majority of cardiac anaesthetists, although believing them to be valuable in medicine, do not want guidelines for cardiac anaesthesia because they are concerned that guidelines would be inflexible and would neither reduce variation in, nor improve the quality of, cardiac anaesthesia.
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The outcome of patients admitted to intensive care after a cardiac arrest was determined by reviewing intensive care unit records at four hospitals for 1993 and 1994. Of the 112 patients identified, 49 survived intensive care of whom 28 were discharged from hospital. In January 1996, 26 of the 28 patients could be traced; 22 of these were still alive. ⋯ In intensive care the factors were the presence of reactive pupils (p < 0.01), Glasgow Coma Score (p < 0.001), APACHE II score (p < 0.05), arterial standard bicarbonate (p < 0.05) and the use of inotropes (p < 0.05). It was not possible to use individual variables to predict outcome at the time of intensive care unit admission. The results suggest that neurological function is an important determinant of outcome and more sensitive neurophysiological testing might be a useful prognostic tool.