Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised comparison of the self-pressurised air-QTM intubating laryngeal airway with the LMA Unique™ in children.
We conducted a randomised trial comparing the self-pressurised air-Q™ intubating laryngeal airway (air-Q SP) with the LMA-Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. ⋯ Both devices provided effective ventilation without the need for airway manipulation. The air-Q SP is an alternative to the LMA-Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.
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Randomized Controlled Trial Comparative Study
Comparison of Macintosh and Airtraq™ laryngoscopes in obese patients placed in the ramped position.
This study compared intubation conditions produced by the Macintosh and Airtraq™ laryngoscopes when used in obese patients in the ramped position. One hundred and thirty-two patients having bariatric surgery were placed in the ramped position and randomly assigned to have their tracheas intubated using either the Macintosh (n=64) or an Airtraq (n=68) laryngoscope. ⋯ One patient in the Macintosh group had a failed intubation and intubation was achieved with the Airtraq. For obese patients in ramped position, Airtraq affords faster tracheal intubation than the Macintosh laryngoscope.
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There is concern that the European Working Time Directive 2009 has led to reduced time available for training, and this study examined if this has been the case. For two identical six-month periods in 1999 (pre-Directive) and 2009 (post-Directive), weekly data were collected on the total number of sessions attended by trainees, the number of supervised sessions and the leave days taken. A total of 5925 theatre sessions were analysed (2353 in 1999 and 3572 in 2009). ⋯ The aggregate median increase in weekly consultant-supervised theatre sessions per trainee increased for ST1-2 trainees (70% increase; p=0.0016) but not for ST3-7 trainees (11% increase; p=0.31). For neither trainee group did training time decline. Our data contradict the hypothesis that the European Working Time Directive has reduced access to training, or suggest that if it has, other factors (such as improved trainee rostering) have overridden its effect.
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We present the case of a 20-year-old woman who developed rhabdomyolysis, disseminated intravascular coagulopathy and multi-organ failure induced by ecstasy. Following initial improvement, she developed delayed rhabdomyolysis then haloperidol-induced neuroleptic malignant syndrome, which was treated with a total of 50 mg.kg(-1) dantrolene. Subsequent genetic testing revealed a novel potentially pathogenic variant in the ryanodine receptor type 1 gene. However, caffeine-halothane contracture testing of the patient's mother who carried the same gene variant was negative for malignant hyperthermia.