Anaesthesia
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Randomized Controlled Trial Comparative Study
Tracheal intubation with restricted access: a randomised comparison of the Pentax-Airway Scope and Macintosh laryngoscope in a manikin.
Ten anaesthetists assessed the ease of tracheal intubation (time to see the glottis, to intubate the trachea and to ventilate), using the Pentax Airway Scope and Macintosh laryngoscope in a manikin, in three simulated circumstances of restricted laryngoscopy: (1) the patient lying supine on the ground; (2) the patient lying supine on the ground with the head close to a wall; (3) the patient confined to a car driver's seat. For the Pentax Airway Scope, intubation was successful (within 2 min) in all three circumstances. ⋯ In circumstances (2) and (3), the Pentax Airway Scope needed significantly shorter time to see the vocal cords (median [95% confidence interval] for difference: 4.5 [0.5-9.5] s in circumstance (2), and 12.5 [7.0-32.5] s in circumstance (3)), shorter time to intubate (median [95% confidence interval] for difference: 21.0 [5.5-38.5] s in circumstance (2), and 40.5 [17.5-64.0] s in circumstance (3)), and shorter time to ventilate the lungs (median [95% confidence interval] for difference: 18. 3 [4.5-36.0] s in circumstance (2), and 47.5 [16.0-84.5] s in circumstance (3)). These results indicate that, in situations where access to the patient's head is restricted, the Pentax Airway Scope is more effective than the Macintosh laryngoscope.
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Although the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. ⋯ Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children.