Anaesthesia
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We retrospectively reviewed 60 normal magnetic resonance imaging scans to assess the anatomical shape of the thecal sac at the L3/4 and L4/5 vertebral interspaces. In all cases the thecal sac was oval at L3/4 but in 26 (43%; 95% CI 31-55%) the thecal sac changed from oval at the L3/4 interspace to triangular at L4/5 (with the apex of the triangle presenting to the posterior epidural space). We propose that this anatomical variant would make it more difficult to obtain cerebrospinal fluid at the lower level, as a slightly lateral approach could lead to identification of the epidural space but failure to puncture the thecal sac. This may offer an explanation for a 'dry tap' when a lower interspace is chosen.
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Comment Letter Case Reports
Central venous catheter occlusion during mitral valve replacement surgery.
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Randomized Controlled Trial
The laryngeal mask airway Supreme--a single use laryngeal mask airway with an oesophageal vent. A randomised, cross-over study with the laryngeal mask airway ProSeal in paralysed, anaesthetised patients.
The LMA Supreme is a new extraglottic airway device which brings together features of the LMA ProSeal, Fastrach and Unique. We test the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSeal and the LMA Supreme in paralysed anesthetised patients. Ninety-three females aged 19-71 years were studied. ⋯ There were no differences in the fibreoptic position of the airway or drain tube. The first attempt and overall insertion success for the gastric tube was similar (LMA ProSeal 91% and 100%; LMA Supreme 92% and 100%). We conclude that ease of insertion, gastric tube placement and fibreoptic position are similar for the LMA ProSeal and LMA Supreme in paralysed, anaesthetised females, but oropharyngeal leak pressure and intracuff pressure are higher for the LMA ProSeal.
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Multicenter Study
Warming of patients during Caesarean section: a telephone survey.
We contacted the duty obstetric anaesthetist in 219 of the 220 consultant-led maternity units in the UK (99.5%) and asked about departmental and individual practice regarding temperature management during Caesarean section. Warming during elective Caesarean section was routine in 35 units (16%). ⋯ Only 18 (8%) departments had specific guidelines for temperature management during Caesarean section. Personal intra-operative practice was variable, although all of those contacted would initiate some form of active temperature management after a mean (SD) volume of blood loss of 1282 (404) ml, length of surgery of 78 (24) min, or core body temperature (if measured) of median (IQR [range]), 36 (35.5-36 [34-37.2]) degrees C.