Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of a new video-optical intubation stylet versus the conventional malleable stylet in simulated difficult tracheal intubation.
Handling and efficacy of a new video-optical intubation stylet were assessed in a simulated difficult tracheal intubation setting and compared with a conventional malleable stylet. Forty-five anaesthetists performed 10 tracheal intubations using both techniques. Laryngoscopy was performed by the observer, who created a grade 3 view according the classification by Cormack and Lehane. ⋯ With the video-optical stylet the trachea was correctly intubated in all 225 attempts; with the malleable stylet 44 (19.6%) oesophageal and 44 (19.6%) endobronchial intubations occurred (p<0.01). The video-optical intubation stylet enabled us to recognise inappropriate tracheal tube positions and to correct them immediately. This equipment can be considered a reliable and effective tool for management of the difficult airway.
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Clinical Trial Controlled Clinical Trial
Evaluation of the use of the Flexiblade.
The Flexiblade is a laryngoscope which has a 'flexible' blade. The 'front' half of the blade can be moved in an anterior direction during laryngoscopy, enhancing the view of the glottis. The degree of movement can be controlled with the lever. ⋯ Ninety-seven per cent of patients with a Cormack and Lehane grading of 2 at normal laryngoscopy were transformed to grade 1 when the lever of the Flexiblade was depressed and 84% of cases with a grading of 3 were transformed to grade 2 or 1. In four patients, there was deterioration in the view of the cords: three patients with grade 1 were transformed to grade 2 and one with grade 2 to grade 3. There was no improvement in one case with grade 2 and three with grade 3.
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Epinephrine and sodium bicarbonate may be added to local anaesthetic solutions in order to reduce the onset time and enhance the quality of epidural anaesthesia for Caesarean section. Such mixtures are sometimes prepared several hours in advance for subsequent use in emergency Caesarean section through a pre-existing epidural catheter. ⋯ Bupivacaine and lidocaine concentrations in all mixtures did not decrease over time regardless of alkalinisation. We do not recommend adding epinephrine to alkalinised epidural solutions that are to be stored for a prolonged period before clinical use.
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Comment Letter Case Reports
Percutaneous tracheostomy in three morbidly obese patients using the 'Blue Rhino' technique.