Anaesthesia
-
Ten volunteers evaluated the performance of four currently available manikins: Airway Management Trainer, Airway Trainer, Airsim and Bill 1 as simulators for the 16 procedures described in the Difficult Airway Society Guidelines (DAS techniques) and eight other advanced airway techniques (non-DAS techniques), by scoring and ranking each manikin and procedure. Manikin performance was unequal (p < 0.0001 for both SCORE and RANK data for both DAS and non-DAS techniques). ⋯ The power to discriminate for individual procedures was considerably lower but for 15 of 16 DAS techniques and 6 of 8 non-DAS techniques, manikin performance differed significantly. Post hoc tests showed significant performance differences between individual manikins for 10 DAS procedures, with the Laerdal manikin performing best.
-
Randomized Controlled Trial Comparative Study
Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models.
Target controlled infusion (TCI) pumps function using a programme based on a pharmacokinetic/pharmacodynamic model. We compared the Marsh and Schnider models to find out which better correlates with the clinically observed effect of propofol as assessed by the Observer Assessment of Alertness/Sedation (OAAS) score and the Bispectral index. ⋯ We calculated the effect site concentration predicted by both models for all the patients. Changes in the sedation score and Bispectral index correlated better with the Marsh than with the Schnider effect site prediction in both study groups.
-
Comparative Study
Evaluation of four airway training manikins as patient simulators for the insertion of single use laryngeal mask airways.
We evaluated the performance of four manikins: Airsim(trade mark), Bill 1, Airway Management Trainer and Airway Trainer, as simulators for insertion of single-use laryngeal mask airways and the reusable LMA Classic. Sixteen volunteer anaesthetists inserted each laryngeal mask airway into each manikin twice. Insertions were scored for ease of insertion, clinical and fibreoptic position, and lung ventilation (maximum score 10). ⋯ The VBM manikin performed best overall and for several individual laryngeal mask airways. The methodology is useful for future evaluations of devices, both manikins and supraglottic airways. Further human clinical research is required.
-
Dapsone can alter the oxygen carrying capacity of haemoglobin. Some patients are more susceptible to these effects because of genetic factors, comorbidities or peri-operative factors such as anaemia. ⋯ A combination of long-term dapsone therapy, co-existing cardiac and respiratory disease, postoperative anaemia and renal impairment contributed to her decompensation, despite a relatively low level of methaemoglobin. Successful management included stopping dapsone therapy, supportive care and administration of ascorbic acid.
-
Case Reports
Successful use of pharyngeal pulse oximetry with the oropharyngeal airway in severely shocked patients.
We describe the successful use of pharyngeal oximetry with the oropharyngeal airway in two patients with severe shock in whom finger pulse oximetry failed. One patient was a 50-year-old man with septic shock and the other a 32-year-old woman with haemorrhagic shock. ⋯ A good waveform was obtained and oxygen saturation was 0-2% lower than arterial samples whereas finger pulse oximetry saturation was unobtainable or much lower than arterial oxygen saturation. Pharyngeal oxygen saturation with the oropharyngeal airway is feasible and more accurate than finger oximetry in low perfusion states.