Anaesthesia
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Randomized Controlled Trial Comparative Study
Blood pressure and heart rate changes during intubation: a comparison of direct laryngoscopy and a fibreoptic method.
Blood pressure and heart rate changes during nasotracheal intubation under general anaesthesia were studied in 100 patients who were randomly allocated to fibreoptic bronchoscope or direct laryngoscopy intubation. Noninvasive blood pressure and heart rate were recorded before and immediately after anaesthesia induction, at anaesthesia intubation and every minute thereafter for 5 min. ⋯ However, the maximum values of heart rate were not significantly different between the two groups. Fibreoptic nasotracheal intubation may result in more severe pressor and tachycardiac responses than direct laryngoscopic nasotracheal intubation.
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Randomized Controlled Trial
Evaluation of intubation using the Airtraq or Macintosh laryngoscope by anaesthetists in easy and simulated difficult laryngoscopy--a manikin study.
The Airtraq Laryngoscope is a novel intubation device which allows visualisation of the vocal cords without alignment of the oral, pharyngeal and tracheal axes. We compared the Airtraq with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty-five anaesthetists were allowed up to three attempts to intubate the trachea in each of three laryngoscopy scenarios using a Laerdal Intubation Trainer followed by five scenarios using a Laerdal SimMan Manikin. ⋯ In the simulated easy laryngoscopy scenarios, there was no difference between the Airtraq and the Macintosh in success of tracheal intubation. The time taken to intubate at the end of the protocol was significantly lower using the Airtraq (9.5 (6.7) vs. 14.2 (7.4) s), demonstrating a rapid acquisition of skills. In the simulated difficult laryngoscopy scenarios, the Airtraq was more successful in achieving tracheal intubation, required less time to intubate successfully, caused less dental trauma, and was considered by the anaesthetists to be easier to use.
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Carbon monoxide can be formed when volatile anaesthetic agents such as desflurane and sevoflurane are used with anaesthetic breathing systems containing carbon dioxide absorbents. This review describes the possible chemical processes involved and summarises the experimental and clinical evidence for the generation of carbon monoxide. We emphasise the different conditions that were used in the experimental work, and explain some of the features of the clinical reports. Finally, we provide guidelines for the prevention and detection of this complication.
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Randomized Controlled Trial Comparative Study
A randomised, crossover study of the Dorges, McCoy and Macintosh laryngoscope blades in a simulated difficult intubation scenario.
The use of alternative adult laryngoscope blades in an unexpected difficult intubation was evaluated with a human patient simulator manikin. Twenty anaesthetists of varying experience attempted to intubate the trachea of a high fidelity simulator in both its normal and difficult intubation settings using Macintosh, Dorges and McCoy laryngoscopes in a randomised order. ⋯ Guidelines recommending the use of an alternative blade in an unexpected difficult intubation scenario have limited supporting evidence. This study does not support this recommendation.