Anaesthesia
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Practice Guideline Guideline
Difficult Airway Society guidelines for management of the unanticipated difficult intubation.
Problems with tracheal intubation are infrequent but are the most common cause of anaesthetic death or brain damage. The clinical situation is not always managed well. The Difficult Airway Society (DAS) has developed guidelines for management of the unanticipated difficult tracheal intubation in the non-obstetric adult patient without upper airway obstruction. These guidelines have been developed by consensus and are based on evidence and experience. We have produced flow-charts for three scenarios: routine induction; rapid sequence induction; and failed intubation, increasing hypoxaemia and difficult ventilation in the paralysed, anaesthetised patient. The flow-charts are simple, clear and definitive. They can be fully implemented only when the necessary equipment and training are available. The guidelines received overwhelming support from the membership of the DAS. ⋯ It is not intended that these guidelines should constitute a minimum standard of practice, nor are they to be regarded as a substitute for good clinical judgement.
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Comment Letter Case Reports
A response to 'Masseter muscle spasm following atracurium', Reddy K & Bromley L, Anaesthesia 2004; 59: 513.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways.
Tracheal intubation with the intubating laryngeal mask airway or the Bonfils intubation fibrescope was performed in 80 patients with predicted difficult airways. Mallampati score, thyromental distance, mouth opening and mobility of the atlanto-occipital joint were used to predict difficult airways. ⋯ Tracheal intubation was significantly slower with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (76 [45-155] s vs. 40 [23-77] s, p < 0.0001. Patients in the Bonfils group suffered less sore throat and hoarseness than those in the other group.
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Randomized Controlled Trial Clinical Trial
Prevention of postoperative sore throat using capsicum plaster applied at the Korean hand acupuncture point.
In a randomised, double-blind, sham-controlled study, we compared the efficacy of capsicum plaster (PAS) applied at the Korean hand acupuncture point for the prevention of postoperative sore throat in 150 patients scheduled to undergo abdominal hysterectomy. The K group had PAS applied at the K-A20 of both hands and placebo tape at both non-acupoints. The PAS was applied prior to induction of anaesthesia and removed 8 h postoperatively. ⋯ The prevalence of moderate to severe sore throat at 24 h was lower for Group K (0%) than for sham and placebo controls (16%[p = 0.038] and 19%[p = 0.032], respectively). There were no differences in the recovery room of the sore throat scores for all groups. We found that the PAS applied at the K-A20 was an alternative method for reducing postoperative sore throat.
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Continuous flow positive pressure devices bridge the gap between mechanical and unsupported ventilation in patients recovering from critical illness. At this point, patients are often fully awake, yet the inflated tracheostomy cuff prevents them from speaking or swallowing. The aim of this study was to investigate the effects of cuff deflation. ⋯ All patients were able to vocalise following cuff deflation. Twelve patients passed a blue dye swallow screen within a day of tolerating cuff deflation. These results suggest that pressures fall slightly following cuff deflation but this is associated with respiratory stability and may allow patients to talk and swallow.