Anaesthesia
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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.
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Randomized Controlled Trial
Nasopharyngeal oxygen insufflation following pre-oxygenation using the four deep breath technique.
This paper evaluates the effectiveness of nasopharyngeal oxygen insufflation following preoxygenation using the four deep breath technique within 30 s, on the onset of haemoglobin desaturation during the subsequent apnoea. Thirty ASA I or II patients were randomly allocated to one of two groups. ⋯ In the control group, SpO2 fell to 95% within a mean (SD) apnoea time of 3.65 (1.15) min, whereas in the study group, SpO2 was maintained in all patients at 100% throughout the 6 min of apnoea, at which point apnoea was terminated and positive pressure ventilation commenced. We conclude that nasopharyngeal oxygen insufflation following pre-oxygenation using the four deep breath technique can delay the onset of haemoglobin desaturation for a significant period of time during the subsequent apnoea.
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Awake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. ⋯ When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2-15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s.