Anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of fibreoptic-guided intubation through ILMA versus intubation through LMA-CTrach.
We compared the time taken to intubate the trachea of a manikin by fibreoptic-guided intubation through an intubating laryngeal mask airway (ILMA-FOS) with intubation through a laryngeal mask airway CTrach (LMA-CTrach). Forty-two anaesthetists participated in this randomised crossover study. ⋯ Thirty (71%) anaesthetists preferred LMA-CTrach as compared with ILMA-FOS (p = 0.008). We conclude that LMA-CTrach is a suitable alternative to fibreoptic-guided intubation through ILMA for the management of unanticipated failed intubation.
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We prospectively assessed common clinical endpoints for their usefulness in avoiding hyperinflation of the cuffs of laryngeal mask airways (slight outward movement) and tracheal tubes (disappearance of an audible leak around the cuff during manual ventilation < 20 cm H(2)O) in 640 children. Cuff pressures were measured at induction and immediately before emergence from anaesthesia. With the laryngeal mask airway (sizes 1-4), the median cuff pressures ranged from 90 to > 120 cm H(2)O at induction and 105 to > 120 cm H(2)O before emergence. ⋯ With the use of nitrous oxide a consistent rise in cuff pressure was observed between the first and second readings whereas cuff pressures remained constant when nitrous oxide was not used. The use of clinical endpoints alone was associated with significant hyperinflation of cuffs with both devices in almost all patients, with an exacerbation when nitrous oxide was used. In order to avoid unnecessary cuff hyperinflation in laryngeal mask airways and tracheal tubes, the routine use of cuff manometers is mandatory in children.
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Multicenter Study
Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust.
Previous reports describe a population of non-cardiac surgical patients at high risk of complications and death. Outcomes are sub-optimal for such patients, perhaps in part related to inadequate provision or ineffective utilisation of critical care resources. In this study, data describing 26,051 in-patient non-cardiac surgical procedures performed in a large NHS Trust between April 2002 and March 2005 were extracted from local databases. ⋯ Of 294 high-risk patients who died, only 144 (49.0%) were admitted to a critical care unit at any time and only 75 (25.6%) of these deaths occurred within a critical care area. Mortality rates were high amongst patients discharged and readmitted to critical care (37.7%) and amongst those admitted to critical care following initial postoperative care on a standard ward (29.9%). These data suggest that the outcome of high-risk general surgical patients could be improved by adequate provision and more effective utilisation of critical care resources.
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Review Meta Analysis
A quantitative review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids.
This quantitative review summarises studies of rigid fibreoptic laryngoscopy systems. In 6622 'normal' patients only the Bonfils and CTrach had homogenous data and first time intubation success rates above 90%. In 1110 patients predicted or known to be difficult to intubate only the Bonfils, CTrach and Glidescope had homogenous data and first-time success rates above 90%. ⋯ The currently available data do not provide strong evidence that these devices should supersede standard direct laryngoscopy for routine or difficult intubation. Further research needs to be of high quality, studying relevant patients to create such evidence. Multicentre collaborations are likely to be needed studying known difficult patients or creating databases reporting the success/failure rate of these devices.
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Randomized Controlled Trial
The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction.
The usefulness of mannitol in the priming fluid for cardiopulmonary bypass is uncertain in patients with normal renal function, and has not been studied in patients with established renal dysfunction. We studied 50 patients with serum creatinine between 130 and 250 micromol.l(-1) having cardiac surgery. ⋯ There were no differences between the groups in plasma creatinine or change in creatinine from baseline, urine output, or fluid balance over the first three postoperative days. We conclude that mannitol has no effect on routine measures of renal function during cardiac surgery in patients with established renal dysfunction.