Anaesthesia
-
Multicenter Study
The extension of epidural blockade for emergency Caesarean section: a survey of current UK practice.
The conversion of epidural analgesia during labour to surgical anaesthesia for Caesarean section can have important medical and medicolegal implications. This survey sought to establish the current management for extending epidural blockade for emergency Caesarean section. A postal questionnaire was sent to the lead obstetric anaesthetist in all maternity units in the UK (n = 254). ⋯ Of the 161 respondents who commenced anaesthesia in the delivery room, 71% (114) did not monitor the patient during transfer, whilst 87% (140) had ephedrine immediately available. Thirty-three respondents reported a total of 43 adverse incidents associated with the extension of epidural blockade. These included high blocks, inadequate blocks and possible intravascular injections, the latter resulting in two seizures and one cardiac arrest.
-
Randomized Controlled Trial
Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.
The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. ⋯ Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.
-
A prospective observational study design was used to evaluate the clinical effectiveness of the Frova single-use tracheal tube introducer. Data were collected from 203 patients. Consultants and trainee anaesthetists completed 61 (30%) and 142 (70%) forms respectively, when the Frova introducer was used. ⋯ Airway trauma was detected in 11/203 (5%) patients. In six of these 11 patients blood was detected on tracheal suction; 'distal hold up' was elicited in five of these six. The Frova introducer has a high success rate for tracheal placement but has noteworthy potential to produce airway trauma.
-
Infants with Pierre Robin syndrome are known to be difficult to intubate. We evaluated the paraglossal approach combined with a gum elastic bougie for intubation of these infants. Whilst under general anaesthesia, a conventional laryngoscopy was performed; if it failed to obtain a laryngoscopic grade I or II view, intubation was attempted using a paraglossal approach and a gum elastic bougie. ⋯ The paraglossal approach combined with a gum elastic bougie made intubation easy in most children with severe Pierre Robin syndrome and difficult laryngoscopy. Therefore we recommend this as the first line for airway management in such children. However, a fibreoptic bronchoscope and an anaesthetist trained in fibreoptic intubation must still be present when dealing with severe Pierre Robin syndrome infants.