Anaesthesia
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The Baska mask is a novel supraglottic airway device. We conducted an initial observational study to assess this device in 30 low-risk female patients. All Baska masks were inserted by a single investigator. ⋯ The mean (SD) airway leak pressure was 35.7 (13.3) cmH(2) O. The incidence of throat pain, dysphonia and dysphagia was low. We conclude that the Baska mask demonstrates a level of utility as an alternative supraglottic airway that is worthy of further clinical study.
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Randomized Controlled Trial Comparative Study
A randomised trial comparing the i-gel (TM) with the LMA Classic (TM) in children.
We performed a prospective, randomised trial comparing the i-gel(TM) with the LMA Classic(TM) in children undergoing general anaesthesia. Ninety-nine healthy patients were randomly assigned to either the i-gel or the LMA Classic. The outcomes measured were airway leak pressure, ease of insertion, time taken for insertion, fibreoptic examination and complications. ⋯ A good fibreoptic view of the glottis was obtained in 74% of the i-gel group and in 43% of the LMA Classic group (p < 0.001). There were no significant complications. In conclusion, the i-gel provided a similar leak pressure, but a shorter insertion time and improved glottic view compared with the LMA Classic in children.
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Acute pulmonary oedema in pregnant women is an uncommon but life-threatening event. The aims of this review are to address why pulmonary oedema occurs in pregnant women and to discuss immediate management. We performed a systematic literature search of electronic databases including MEDLINE, EMBASE and the Cochrane Library, using the key words obstetrics, pregnancy, acute pulmonary oedema, pregnancy complications, maternal, cardiac function and haemodynamics. ⋯ Pre-eclampsia remains an important cause of hypertensive acute pulmonary oedema in pregnancy and preventive strategies include close clinical monitoring and restricted fluid administration. Immediate management of acute pulmonary oedema includes oxygenation, ventilation and circulation control with venodilators. Pregnancy-specific issues include consideration of the physiological changes of pregnancy, the risk of aspiration and difficult airway, reduced respiratory and metabolic reserve, avoidance of aortocaval compression and delivery of the fetus.
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Randomized Controlled Trial
Combined spinal epidural vs epidural labour analgesia: does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine?
Labour analgesia initiated using a combined spinal-epidural (CSE) technique may reduce subsequent epidural bupivacaine requirements compared with an epidural-only technique. We compared the minimum local analgesic concentrations (MLAC) of epidural bupivacaine following initial intrathecal or epidural injection. In a prospective, double-blind study, 115 women requesting epidural analgesia were randomly assigned to receive either an epidural with bupivacaine 20 mg and fentanyl 40 μg or a CSE with intrathecal bupivacaine 2.5 mg and fentanyl 5 μg. ⋯ When further analgesia was requested, bupivacaine 20 ml was given, and the concentration was determined using the technique of up-down sequential allocation. The MLAC of bupivacaine in the epidural group was 0.032% wt/vol (95% CI 0.020-0.044) compared with 0.047% wt/vol (95% CI 0.042-0.052) in the CSE group. Bupivacaine requirements for the second injection were increased following intrathecal analgesia by a factor of 1.45 (p = 0.026) compared with epidural analgesia.