Anaesthesia
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Thyromental distance (TMD) measurement is commonly used to predict difficult intubation. We surveyed anaesthetists to determine how this test was being performed. Comparative accuracy of ruler measurement and other forms of measurement were also assessed in a meta-analysis of published literature. ⋯ In terms of distance, the minimum acceptable TMD was felt to be 6.5 cm by 55% of respondents. However, the actual width of three fingers was (range) 4.6-7.0 cm (mean 5.9 cm), with significant differences between genders and between proximal and distal interphalangeal joints. The meta-analysis showed ruler measurement increased test sensitivity (48% (95% CI 43-53) vs 16% (95% CI 14-19) without a ruler), when predicting difficult intubation.
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Randomized Controlled Trial
Effects of different doses of remifentanil on the end-tidal concentration of sevoflurane required for tracheal intubation in children.
We investigated the effects of different doses of remifentanil on the end-tidal concentration of sevoflurane required for tracheal intubation in children without the use of neuromuscular blocking drugs. One hundred and thirty paediatric patients, aged 3-8 years, were randomly allocated to receive no remifentanil (group control) or remifentanil 0.1 microg kg(-1) min(-1) (group remi(0.1)), 0.2 microg kg(-1) min(-1) (group remi(0.2)), 0.3 microg kg(-1) min(-1) (group remi(0.3)). All patients were anaesthetised using 5% sevoflurane. ⋯ Successful intubation was defined as excellent or good intubating conditions. The end-tidal concentration (SD) of sevoflurane for successful tracheal intubation in 50% of children (ED(50)) were 5.16 (0.22)% in control, 3.27 (0.18)%, 1.81 (0.20)% and 1.01 (0.11)%, in remi(0.1), remi(0.2), and remi(0.3) groups, respectively. Using probit analysis, the 95% effective dose (ED(95)) of sevoflurane were 5.60% (95% CI 5.35-7.66), 3.77% (95% CI 3.45-7.74), 2.18% (95% CI 1.96-3.86), 1.19% (95% CI 1.06-1.82) in control, remi(0.1), remi(0.2), and remi(0.3) groups, respectively.
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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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Little data exists regarding the frequency of neurological complications following ultrasound guided peripheral nerve blockade. Therefore, we studied single injection and continuous ultrasound guided interscalene, supraclavicular, infraclavicular, femoral and sciatic nerve blocks in patients undergoing orthopaedic extremity surgery. All patients were contacted during postoperative weeks 2-4 and questioned for numbness or altered sensation anywhere in the involved extremity, and pain or weakness unrelated to surgery. ⋯ Most symptoms were due to causes unrelated to the block. Of 452 patients directly questioned at the time of the block, new neurological symptoms were more common in patients who experienced procedure-induced paraesthesia (odds ratio = 1.7, p = 0.029). The postoperative neurological symptom rate in this series is very similar to those previously reported following traditional techniques.