Anaesthesia
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Advances in technology have resulted in the development of several depth-of-anaesthesia monitors. Whether any of these monitors can reduce the incidence of awareness is an important issue for anaesthetists and their patients. We therefore surveyed a random selection of anaesthetists, asking for their opinions of awareness and depth-of-anaesthesia monitoring in current clinical practice. ⋯ Anaesthetists rated awareness on an 11-point scale as only a moderate problem, median (interquartile range) 5 (2-7). Older anaesthetists were less likely to rate the importance of awareness highly (p = 0.009) and to use awareness monitoring (p = 0.001). Anaesthetists are prepared to use depth-of-anaesthesia monitoring more widely if it can be shown to prevent most cases of awareness in routine practice.
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Letter Case Reports
Carbon dioxide pneumothorax during laparoscopic fundoplication.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of simulated difficult intubation with multiple-use and single-use bougies in a manikin.
In a randomised cross-over study, 20 anaesthetists attempted to place a multiple- or single-use bougie in the trachea of a manikin, in which a grade 3 Cormack and Lehane laryngoscopic view was simulated. The anaesthetists made two attempts at placement with each bougie and were blinded to success (tracheal placement) or failure (oesophageal placement). ⋯ The success rates for the second attempts were similar to those for the first attempts with both bougies. There is an increased risk of failure to intubate the trachea when using a single-use bougie, and this must be weighed against the unquantified risk of cross-infection from prions when using a multiple-use bougie.
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Randomized Controlled Trial Clinical Trial
A comparison of the laryngeal mask airway and PA(Xpress) for short surgical procedures.
Sixty adult patients undergoing minor peripheral surgery under general anaesthesia were randomly allocated to receive either the laryngeal mask airway (laryngeal mask airway; size 4 for females and size 5 for males) or the PAXpress (adult size), inserted by a single operator with experience of > 50 insertions of each device. The laryngeal mask airway was correctly placed on the first attempt in 27 patients (90%) compared with 20 patients (67%) when using the PAXpress (p < 0.01). ⋯ Mean (SD) total placement time was shorter with the laryngeal mask airway [24.6 (3.1) s] than with the PAXpress[35.4 (2.5) s; p < 0.01]. The most common complication was sore throat, which occurred less frequently with the laryngeal mask airway (8 patients; 26%) than with the PAXpress (15 patients; 53.5%; p < 0.001).
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Randomized Controlled Trial Clinical Trial
The effect of intra-operative video on patient anxiety.
We conducted a randomised controlled study to evaluate whether watching video compact discs intra-operatively using a liquid crystal display (LCD) unit decreased anxiety. Forty-four patients undergoing elective surgery under regional anaesthesia were assigned to either the LCD or control group. Anxiety was measured using the Chinese version of the State-Trait Anxiety Inventory (STAI) and visual analogue score (VAS). ⋯ The state anxiety of the LCD group [35.50 (7.96)] measured immediately postoperatively was significantly lower than the control group [41.50 (9.02); p = 0.03]. The median (range) reduction in VAS anxiety score was not significantly greater in the LCD group [20 (20 to 80) mm] compared with the control group [12.5 (70 to 60) mm]. Watching video intra-operatively reduces patient anxiety as measured by the STAI.