Anaesthesia
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Randomized Controlled Trial Comparative Study
A comparison of the Airway Scope and McCoy laryngoscope in patients with simulated restricted neck mobility.
We compared the efficacy of the Airway Scope and McCoy laryngoscope as intubation tools with the neck stabilised by a rigid cervical collar. After induction of anaesthesia and neck stabilisation, 100 patients were randomly assigned to tracheal intubation with an Airway Scope or McCoy laryngoscope. ⋯ However, the mean (SD) time required for successful intubation was shorter with the Airway Scope (30 (7) s) than with the McCoy laryngoscope (40 (14) s; p < 0.0001). The incidences of intubation complications were similar, but oesophageal intubation (in six cases) occurred only with McCoy laryngoscope.
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Comparative Study
Comparison of mechanomyography and acceleromyography for the assessment of rocuronium induced neuromuscular block in myotonic dystrophy type 1.
We measured acceleromyography and mechanomyography simultaneously with monitoring of rocuronium-induced neuromuscular block in four patients with myotonic dystrophy type 1. Furthermore, we compared neuromuscular block measures from these patients with those from normal controls from previous studies. In myotonic dystrophy type 1 patients, the dose-response curve obtained with acceleromyography was steeper and right-shifted compared with that obtained using mechanomyography. ⋯ In both patients and normal controls, neuromuscular block recovered faster with acceleromyography. However, in one patient with severe muscle wasting, recovery of neuromuscular block was prolonged. We conclude that mechanomyography and acceleromyography cannot be used interchangeably to monitor neuromuscular block in myotonic dystrophy type 1 patients.
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We investigated the artefacts created during magnetic resonance imaging by five different laryngeal mask airways: the Classic (cLMA); the LMA ProSeal; the LMA Unique; the Ambu Disposable Laryngeal Mask; the LMA Supreme; and one other supraglottic airway device, the i-gel supraglottic airway. The devices were placed on top of and inside a phantom simulator to resemble the position in vivo. ⋯ Artefacts were more prominent with the ProSeal. There were no artefacts with the Ambu Disposable Laryngeal Mask or the i-gel.
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Case Reports
Spinal anaesthesia and caesarean section in a patient with hypofibrinogenaemia and factor XIII deficiency.
We report the peri-operative management of a 32-year-old patient suffering from symptomatic hypofibrinogenaemia and factor XIII deficiency scheduled for caesarean section. Starting with an impaired fibrinogen (1.04 g x l(-1)) and factor XIII level (48%), fibrinogen and factor XIII administration was guided by point-of-care rotational thrombelastometry (ROTEM) to achieve normal whole blood coagulation, which allowed uncomplicated spinal anaesthesia and an uneventful surgical procedure. We conclude that rotational thrombelastometry may be suitable to guide administration of coagulation factors in patients with hereditary bleeding disorders and allow otherwise contraindicated neuraxial anaesthesia and surgery to proceed without increased risk of blood loss.