Anaesthesia
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The inability to maintain oxygenation by non-invasive means is one of the most pressing emergencies in anaesthesia and emergency care. To prevent hypoxic brain damage and death in a 'cannot intubate, cannot oxygenate' situation, emergency percutaneous airway access must be performed immediately. Even though this emergency is rare, every anaesthetist should be capable of performing an emergency percutaneous airway as the situation may arise unexpectedly. ⋯ There is, however, no consensus on the best technique or device. As each has its limitations, it is recommended that all anaesthetists are skilled in more than one technique of emergency percutaneous airway. Avoiding delay in initiating rescue techniques is at least as important as choice of device in determining outcome.
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Review Meta Analysis Comparative Study
Airtraq laryngoscope versus conventional Macintosh laryngoscope: a systematic review and meta-analysis.
The Airtraq laryngoscope is a single-use laryngoscope designed to facilitate tracheal intubation in patients with either normal or difficult airways. The aim of this systematic review and meta-analysis was to compare the Airtraq with the conventional Macintosh laryngoscope. Data were retrieved from Medline, Embase, the Cochrane register of controlled trials, and by a manual search of bibliographies. ⋯ The Airtraq reduced intubation time significantly (mean difference -15 s; 95% CI -25 to -4 s, p < 0.00001) used by both experienced anaesthetists and novices, and it increased the first attempt success rate only in novices (relative risk 1.25; 95% CI 1.05-1.49, p = 0.07). The incidence of oesophageal intubation (relative risk 0.12; 95% CI 0.03-0.48, p < 0.05) was significantly reduced by the Airtraq. We conclude that the Airtraq laryngoscope facilitates a more rapid and accurate intubation, especially when used by novices.
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There is no consensus as to the ideal approach for the anaesthetic management of the adult obstructed airway and there are advocates of awake fibreoptic intubation, inhalational induction and intravenous induction techniques. This review considers the different options available for obstruction at different anatomical levels. Decisions must also be made on the urgency of the required intervention. Particular controversies revolve around the role of inhalational vs intravenous induction of anaesthesia, the use or avoidance of neuromuscular blockade and the employment of cannula cricothyroidotomy vs surgical tracheostomy.
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There has been a great deal of progress in our understanding and management of rheumatoid arthritis in recent years. The peri-operative management of rheumatoid arthritis patients can be challenging and anaesthetists need to be familiar with recent developments and potential risks of this multi system disease.
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We highlight the areas we think important for future development of the subspeciality. The ultimate goal is to improve patient care and safety and to do this, we need to identify how and where episodes of harm arise. Simply continuing with current practice does not represent the best path towards our ultimate goal; objective evidence is needed to inform changes in practice.