Anaesthesia
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Randomized Controlled Trial Comparative Study
Effect of orientation of a standard polyvinyl chloride tracheal tube on success rates during awake flexible fibreoptic intubation.
We conducted a randomised study in 70 patients to assess the effect of orientation of a standard polyvinyl chloride tracheal tube on the ease of railroading the tube during awake fiberoptic orotracheal intubation. Conventional orientation of the tube (with the bevel of the tube directed to the patient's left) was compared with orientation of the tube with the bevel facing posteriorly. The success rate of intubation at the first attempt was higher with the bevel oriented posteriorly (35/35; 100%) than with the conventional orientation (21/35; 60%; p = 0.0001), and the intubating time was shorter (median (range) 7 (5-11) s and 11 (5-60) s, respectively; p = 0.0001). We recommend that the tracheal tube should be aligned in this manner when railroading it over the fibrescope during awake fibreoptic orotracheal intubation.
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Multicenter Study
Therapeutic hypothermia after cardiac arrest: a survey of practice in intensive care units in the United Kingdom.
A telephone survey was carried out on the use of hypothermia as part of the management of unconscious patients following cardiac arrest admitted to United Kingdom (UK) intensive care units (ICUs). All 256 UK ICUs listed in the Critical Care Services Manual 2004 were contacted to determine how many units have implemented therapeutic hypothermia for unconscious patients admitted following cardiac arrest, how it is implemented, and the reasons for non-implementation. ⋯ Sixty-seven (28.4%) ICUs have cooled patients after cardiac arrest, although the majority of these have treated fewer than 10 patients. The commonest reasons given for not using therapeutic hypothermia in this situation are logistical or resource issues, or the perceived lack of evidence or consensus within individual ICU teams.
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Randomized Controlled Trial Comparative Study
The anatomical position of three extraglottic airway devices in patients with clear airways.
We tested the hypothesis that, in patients with clear airways, the anatomical position of three single-use extraglottic airway devices is similar. The airways studied were: the laryngeal mask airway unique (LMA-U), the Softseal laryngeal mask airway (SS-LM) and the Cobra perilaryngeal airway (Cobra-PLA). Three hundred spontaneously breathing patients were randomly allocated to have their airway managed using one of these three supraglottic airway devices. ⋯ The cuff was more frequently in the midline with the LMA-U than with the SS-LM (p = 0.002). We conclude that the anatomical position of the LMA-U and SS-LMA is superior to that of the Cobra-PLA in patients with clear airways. The mask aperture bars probably have no anatomical utility and predispose to herniation of the pharyngeal structures.
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We investigated on-call stress and its consequences among anaesthetists. A questionnaire was sent to all working Finnish anaesthetists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. ⋯ Moderate burnout was present in 18%vs 45% (p = 0.008) and exhaustion in 32% and 68% (p = 0.015), in the lowest vs highest workload category, respectively. The symptoms were significantly associated with stress, gender, perceived sleep deprivation, suicidal tendencies and sick leave. Being frequently on call correlates with severe stress symptoms and these symptoms are associated with sick leave.
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Randomized Controlled Trial
The use of pre-operative intrathecal morphine for analgesia following coronary artery bypass surgery.
With the emergence of rapid extubation protocols following cardiac surgery, providing adequate analgesia in the early postoperative period is important. This prospective randomised double-blind study investigated the benefits of pre-operative intrathecal administration of low dose morphine in patients undergoing coronary artery bypass graft surgery. Postoperative analgesia, pulmonary function, stress response and postoperative recovery profile were assessed. ⋯ In the intrathecal group, the total consumption of intravenous morphine following surgery was significantly reduced by 40% and patients reported lower pain scores at rest, during the first 24 h following extubation. Peak expiratory flow rate was greater and postoperative catecholamine release was significantly lower. Patients in the control group had a higher incidence of reduced respiratory rate following extubation.