Anaesthesia
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Multicenter Study
Mortality related to anaesthesia in France: analysis of deaths related to airway complications.
Death certificates from the French national mortality database for the calendar year 1999 were reviewed to analyse cases in which airway complications had contributed to peri-operative death. Respiratory deaths (and comas) found in a previous national 1978-82 French survey (1:7960; 95% CI 1:12,700 to 1:5400) were compared with the death rate found in the present one: 1:48,200 (95% CI 1:140,000 to 1:27,500). ⋯ In most cases, there were both inadequate practice and systems failure (inappropriate communication between staff, inadequate supervision, poor organisation). This large French survey shows that deaths associated with respiratory complications during anaesthesia have been strikingly reduced during this 15-year period.
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Review Meta Analysis
A meta-analysis of the utility of C-reactive protein in predicting early, intermediate-term and long term mortality and major adverse cardiac events in vascular surgical patients.
We conducted a meta-analysis of the utility of pre-operative C reactive protein (CRP) in predicting early (< 30 days), intermediate (30-180 days) and long term (> 180 days) mortality and major adverse cardiac events (MACE; cardiac mortality and nonfatal myocardial infarction (MI) combined) following vascular surgery. Of 291 studies identified, ten prospective patient cohorts were identified. ⋯ Intermediate-term all-cause mortality, cardiac death and MACE showed a trend to a worse outcome (odds ratio (OR) 9.07, 95% confidence interval (CI) 0.86-96.28, p = 0.07; OR 8.71, 95% CI 0.5-153.1, p = 0.14 and OR 2.81, 95% CI 0.78-5.18, p = 0.15 respectively). Long term all cause mortality (OR 2.40, 95% CI 1.15-5.02, p = 0.02), cardiac death (OR 5.66, 95% CI 1.71-18.73, p = 0.005) and MACE (OR 2.76, 95% CI 1.38-5.55, p = 0.004) were significantly increased.
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Comparative Study
A simple fibreoptic assisted laryngoscope for paediatric difficult intubation: a manikin study.
The fibreoptic assisted laryngoscope is a new airway device. We compared the fibreoptic assisted laryngoscope with the Bullard laryngoscope, Macintosh laryngoscope and fibreoptic bronchoscope in a manikin with a simulated Cormack and Lehane Grade 4 laryngoscopic view. Eighteen anaesthetists intubated the manikin's trachea using these devices and the success rate of intubation was measured. ⋯ Tracheal intubation using the fibreoptic assisted laryngoscope or Bullard laryngoscope is easier than that using the Macintosh laryngoscope or fibreoptic bronchoscope by subjective difficulty score. All of the intubations were successful with the fibreoptic assisted laryngoscope without practice. These results suggest that fibreoptic assisted laryngoscope may be a useful tool for paediatric difficult intubation.
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Biography Historical Article
The Hewitt airway--the first known artificial oral 'air-way' 101 years since its description.
The year 2008 marked 100 years since the publication of Sir Frederic W. Hewitt's description of his artificial airway. Hewitt's airway was the first known oral airway and laid the foundations for the numerous other airways that were later developed. Oral airways made anaesthesia safer and significantly reduced the trauma associated with earlier attempts at managing the obstructed airway.