Anaesthesia
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Randomized Controlled Trial Comparative Study
A comparison of the Soft Seal disposable and the Classic re-usable laryngeal mask airway.
Many new supraglottic airway devices have been recently introduced, their development motivated by the need for a single-use equivalent to the original re-usable laryngeal mask airway. We performed a randomised cross-over study in spontaneously breathing patients comparing the re-usable Laryngeal Mask Airway-Classic (LMA) and the disposable Soft Seal Laryngeal Mask in sizes 3, 4 and 5. Sixty patients had an LMA and a disposable laryngeal mask placed in random order. ⋯ The disposable laryngeal mask required significantly less air to inflate the cuff to produce a seal (10 [10-25] ml with disposable laryngeal mask and 15 [10-30] ml with laryngeal mask) and the cuff pressure produced was significantly lower (35 [20-80] cmH(2)O with disposable laryngeal mask and 75 [20-120] cmH(2)O with LMA). Data are median and range. We conclude that the disposable laryngeal mask is an acceptable alternative to the re-usable LMA.
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Melodic alarms proposed in the IEC 60601-1-8 standard for medical electrical equipment were tested for learnability and discriminability. Thirty-three non-anaesthetist participants learned the alarms over two sessions of practice, with or without mnemonics suggested in the standard. Fewer than 30% of participants could identify the alarms with 100% accuracy at the end of practice. ⋯ Participants responded faster (p < 0.00001) and more accurately (p = 0.002) to medium priority alarms than to high priority alarms, even though they rated the high priority alarms as sounding more urgent (p < 0.00001). Participants with at least 1 year of formal musical training identified the alarms more accurately (p = 0.0002) than musically untrained participants, and found the task easier overall (p < 0.00001). More intensive studies of the IEC 60601-1-8 alarms are needed for their effectiveness to be determined.
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We prospectively estimated the prevalence of heart murmurs in 2522 consecutive adult non-cardiac surgery patients during pre-operative evaluation. Factors that contribute to the detection of a heart murmur were identified, and echocardiography was used to evaluate to what extent a murmur reflected presence of valvular heart disease. A cardiac murmur was detected in 106 patients (prevalence 4.2%, 95% CI: 3.5-5.1%). ⋯ Murmurs in patients younger than 40 years never reflected valvular heart disease. Pre-operative cardiac auscultation seems only reasonable in patients aged 40 years or older. Subsequent echocardiography in these selected patients is necessary.
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Case Reports
Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus.
We report a patient, 33 weeks pregnant with twins, who sustained a ruptured splenic artery aneurysm. This presented with left sided chest pain, breathlessness, low oxygen saturations and electrocardiogram (ECG) changes supportive of a diagnosis of massive pulmonary embolus. The diagnosis of splenic artery rupture was made at emergency Caesarean section performed for fetal distress.