Anaesthesia
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Randomized Controlled Trial Clinical Trial
An investigation into the quantity of secretions removed by inflated and deflated laryngeal mask airways.
It has been suggested that removal of a laryngeal mask airway with the cuff inflated may remove more secretions than with the cuff deflated. We performed a study to determine whether this suggestion is correct. ⋯ The mean (SD) increase in laryngeal mask airway weight was 2.45 (1.47) g with the cuff deflated and 3.03 (1.76) g with the cuff inflated (p = 0.03). We conclude that removal of the laryngeal mask airway with the cuff inflated removes approximately 0.5 g more secretions than with the cuff deflated.
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Randomized Controlled Trial Clinical Trial
Fentanyl supplementation of sevoflurane induction of anaesthesia.
Sevoflurane induction of anasthesia has been examined extensively, but little is known about the usefulness of other drugs as adjuncts to hasten and smooth the process. Sixty patients, undergoing surgery of a type suitable for a spontaneous respiration, laryngeal mask airway anasthetic technique, were randomly allocated to receive 1.0 microgram.kg-1 intravenous fentanyl or the equivalent volume of normal saline, 30 s prior to triple-breath induction with sevoflurane. The study was double-blind. ⋯ However, there was a difference in the incidence of adverse airway events (breath-holding, coughing and laryngospasm) between the two groups (16.5% in the fentanyl group and 40% in the placebo group); this did not reach statistical significance. Both groups were haemodynamically stable throughout induction, although the fentanyl group had a statistically significant decrease in systolic blood pressure at 4 min compared with the placebo group, which was not considered clinically relevant. We conclude that fentanyl has no significant influence over the speed and quality of sevoflurane induction.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of blind and lightwand-guided tracheal intubation through the intubating laryngeal mask.
We have tested the hypothesis that intubation success rates, haemodynamic changes, airway complications and postoperative pharyngolaryngeal morbidity differ between blind and lightwand-guided intubation through the intubating laryngeal mask airway. One hundred and twenty paralysed anasthetised adult patients (ASA I-II, no known or predicted difficult airways) were assigned in a random manner to one of two equal-sized groups. In the blind group, patients were intubated blindly through the intubating laryngeal mask airway. ⋯ Oesophageal intubation occurred more frequently in the blind group (18 vs. 0%, p = 0.002). The incidence and severity of mucosal injury, sore throat and hoarseness were similar between the groups. We conclude that lightwand-guided intubation through the intubating laryngeal mask is superior to the blind technique.
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Review
Peripartum general anasthesia without tracheal intubation: incidence of aspiration pneumonia.
This study estimated the incidence of pulmonary aspiration during general anasthesia for obstetric procedures performed in the peripartum period (Caesarean sections were not studied). The records of 1870 patients anasthetised without tracheal intubation were reviewed retrospectively. The diagnosis of aspiration was based on the anasthetist's written remarks and the postoperative course. ⋯ No cricoid pressure or tracheal intubation was performed. A single case of mild aspiration was detected in a woman anasthetised with methohexital (an incidence of 0.053%). These results suggest that the risk of aspiration during general anasthesia without tracheal intubation, during and immediately after delivery, may not be higher in obstetric patients in the peripartum period, as has been reported previously.