Anaesthesia
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Randomized Controlled Trial
The impact of manual in-line stabilisation on ventilation and visualisation of the glottis with the LMA CTrach: a randomised crossover trial.
The LMA CTrach (CTrach) enables ventilation, glottis visualisation and tracheal intubation via a laryngeal mask conduit. The CTrach has been successfully used in patients with cervical spine pathology, but it is unclear if cervical spine immobilisation affects its ease of use. In this randomised crossover trial, the CTrach was used once with and once without manual in-line stabilisation of the cervical spine in every patient. ⋯ With manual in-line stabilisation, the time to achieving a glottic views was 42 [30-63] s compared with 39 [25-53] s without stabilisation (p = 0.019). There was no difference in the success rates of achieving ventilation and glottic views. These results suggest that manual in-line stabilisation does not affect use of the CTrach.
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Reported are three cases of successful tracheal intubation using the McGrath Video Laryngoscope in awake patients. All three patients had predicted difficult direct laryngoscopy and signs of upper airway obstruction.
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Accurate prediction of neurological outcome in survivors of cardiac arrest may be difficult. We report the case of a 44-year-old survivor of a hypoxic cardiac arrest who repeatedly developed relentless myoclonic jerks on attempted discontinuation of his propofol infusion. These were initially thought to represent myoclonic status epilepticus before the correct diagnosis of Lance-Adams syndrome was made. ⋯ It is characterised by intention myoclonus but preserved intellect. Accurate distinction between myoclonic status epilepticus and Lance-Adams syndrome is vital as they have very different prognoses. The different pathophysiology and distinguishing clinical features of these two conditions are highlighted.
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In parts of the world where supplies of oxygen and electricity are erratic, ventilating patients' lungs can be problematic. Should the electricity supply fail, gas driven ventilators have an advantage as they can continue functioning. However, many are extravagant in their requirement for the driving gas. ⋯ The period of mechanical ventilation from a single E-size cylinder ranged from 11 h 8 min (SD 4 min) with a minute volume of 7 l min(-1) to 18 h 15 min (SD 7 min) with a minute volume of 3 l min(-1). The mean fractional inspired oxygen concentration achieved by recycling the driving gas without further inspired oxygen supplementation was 0.33. We conclude that the Glostavent ventilator performs as efficiently and cost effectively as predicted.
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Maternal heart rate variability of 62 parturients were compared based on their choice of using (epidural group, 44 women) or not using (control, 18 women) epidural analgesia. Baseline heart rate variability and visual analogue scores were recorded when the cervix of the parturient dilated to 2-4 cm, and paired data were collected 1 h later. ⋯ Almost all heart rate variability measures were unchanged 1 h later in both groups. We concluded that parturients who chose epidural analgesia had greater heart rate variability, and that percentage of absolute difference in successive RR intervals exceeding 20 ms could reflect their likelihood of requesting epidural analgesia at the beginning of labour.