Anaesthesia
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Comparative Study
Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices.
We evaluated the performance of four currently available manikins: Airway Management Trainer (Ambu, UK), Airway Trainer (Laerdal, Norway), Airsim (Trucorp, Ireland), 'Bill 1' (VBM, Germany), with eight supraglottic airway devices: Airway Management Device, Cobra Perilaryngeal Airway, Combitube, i-Gel, Laryngeal Tube, Laryngeal Tube Disposable, Laryngeal Tube Suction II and Streamlined Liner of the Pharynx Airway. Ten anaesthetists inserted each supraglottic airway device twice into each manikin. Each insertion was scored and ranked. ⋯ The Trucorp manikin performed adequately for all supraglottic airway devices. Comparing supraglottic airway devices, i-Gel insertion was significantly the easiest. Our results show that manikin performance for supraglottic airway device insertion is unequal, which has implications for selecting manikins for supraglottic airway device training and for manikin studies assessing performance of supraglottic airway devices.
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This study sought to determine whether it is possible reliably to avoid phrenic nerve block using the bent needle technique for continuous supraclavicular brachial plexus anaesthesia. In a prospective study, 100 patients undergoing a variety of upper extremity surgical procedures were studied. ⋯ Factors were identified in all three cases that we think contributed to the phrenic nerve blocks. We think it is possible to provide continuous supraclavicular regional anaesthesia and analgesia for a wide range of upper extremity operations without phrenic nerve blockade.
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We describe a case of a 19-year-old man who developed traumatic pulmonary pseudocysts after a rollover road traffic crash. These were associated with significant pulmonary haemorrhage requiring a period of mechanical ventilation, but resolved without specific intervention. Review of the literature confirms that this rare complication of blunt chest trauma occurs usually in young adults and, although normally benign, can be associated with life-threatening haemoptysis and secondary infection.
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Comparative Study
Tracheal intubation via the Classic and Proseal laryngeal mask airways: a manikin study using the Aintree Intubating Catheter.
Fibreoptic-assisted tracheal intubation with an Aintree Intubating Catheter via a dedicated airway is sometimes recommended when conventional tracheal intubation fails. This study compares the use of the Classic and Proseal laryngeal mask airways (LMA) for this purpose in a manikin. Twenty-five anaesthetists of all grades performed two intubations with each device. ⋯ Subjective comments favoured the LMA Proseal (p < 0.05), although the clinical importance of these comments is difficult to determine. This study has shown that, in a manikin, fibreoptic guided intubation via an LMA Proseal is at least as easy and reliable as through an LMA Classic. In view of the potential advantages of the LMA Proseal for airway rescue and management of the difficult airway, this study suggests a clinical evaluation of the use of the combination of an LMA Proseal and an Aintree Intubating Catheter in patients is justified.