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
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.
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Patients with suspected or symptomatic cardiac disease, associated with increased peri-operative risk, are often seen by anaesthetists in the pre-assessment clinic. The use of transthoracic echocardiography in this setting has not been reported. This prospective observational study investigated the effect of echocardiography on the anaesthetic management plan in 100 patients who were older than 65 years or had suspected cardiac disease. ⋯ Haemodynamically significant cardiac disease was revealed in 31 patients, resulting in a step-up of treatment in 20 patients, including: cardiology referral (four patients); altered surgical (two) and anaesthetic (four) technique; use of invasive monitoring (13); planned use of vasopressor infusion (10); and postoperative high dependency care (five). Reassuring negative findings in 69 patients led to a step-down in treatment in 34 patients: altered anaesthetic technique (six); procedure not cancelled (10); cardiology referral not made (10); use of invasive monitoring not required (seven); and high dependency care not booked (11). We conclude that focused transthoracic echocardiography in the pre-operative clinic is feasible and frequently alters management in patients with suspected cardiac disease.
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Guideline
Checking anaesthetic equipment 2012: association of anaesthetists of Great Britain and Ireland.
A pre-use check to ensure the correct functioning of anaesthetic equipment is essential to patient safety. The anaesthetist has a primary responsibility to understand the function of the anaesthetic equipment and to check it before use. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so. ⋯ A two-bag test should be performed after the breathing system, vaporisers and ventilator have been checked individually. A record should be kept with the anaesthetic machine that these checks have been done. The 'first user' check after servicing is especially important and must be recorded.