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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The extent of a regional block for Caesarean section must be tested and documented before surgery commences. In recent years a block to 'touch' that includes T5 has increasingly been considered the best predictive test for a pain-free Caesarean section. Our survey examines the consistency with which different anaesthetists identified the location of the T5 dermatome. ⋯ Overall there was good agreement on the location of the T5 dermatome, but one in seven anaesthetists were inaccurate by two or more dermatomes. There were no statistically significant differences between the subgroups of senior house officer, specialist registrar and consultant anaesthetists. The knowledge of relevant dermatome levels should be an integral part of obstetric anaesthetic training.
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Comparative Study
A comparison of the Seeing Optical Stylet and the gum elastic bougie in simulated difficult tracheal intubation: a manikin study.
Management of the difficult airway is one of the major challenges that anaesthetists face. The flexible fibreoptic scope is widely available but its use requires a level of skill, training and continued practice that is not universally found in all anaesthetists, particularly trainees. The Seeing Optical Stylet is a new, semirigid fibreoptic stylet 'scope. ⋯ Oesophageal intubation occurred six times with the bougie but did not occur with the Seeing Optical Stylet (p = 0.011). We conclude that the Seeing Optical Stylet may be superior to the bougie in difficult tracheal intubation. We feel that the results of this manikin trial are sufficiently encouraging to proceed to a clinical trial in patients.
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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.