Anaesthesia
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Editorial Comment
Extubation of the difficult airway--an important but neglected topic.
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It remains unclear whether type 2 diabetics treated with either insulin or oral hypoglycaemic agents have the same incidence of cardiac morbidity and mortality after major non-cardiac surgery. We prospectively studied 360 type 2 diabetic patients undergoing major non-cardiac surgery of which 105 were treated with insulin only, 171 were treated with oral hypoglycaemics only and 84 were treated with a combination of insulin and oral hypoglycaemics. ⋯ Insulin treatment was independently associated with increased mortality after 30 days (hazard ratio 3.93; 95% CI 1.22-12.64; p = 0.022) and 12 months (hazard ratio 2.03; 95% CI 1.16-3.58; p = 0.014) after multivariate adjustment for age, sex and the revised cardiac risk index (insulin treatment excluded). The increased mortality in insulin-treated diabetic patients may be due to a more progressive disease state in these patients rather than the treatment modality itself.
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Randomized Controlled Trial Comparative Study
Easy and difficult nasal intubation--a randomised comparison of Macintosh vs Airtraq® laryngoscopes.
A new Airtraq(®) laryngoscope has been developed for nasal intubation. We prospectively compared tracheal intubation efficiency of the Airtraq for nasotracheal intubation vs that of the Macintosh laryngoscope in 200 patients. Depending on pre-operative airway evaluation, the patients were allocated to expected easy (n = 100) or difficult (n = 100) intubation groups, on the basis of mouth opening ≤ 2.5 cm, modified Mallampati score of 4, history of difficult intubation, obvious tumour or swelling. ⋯ All easy intubations were successfully performed with the respective technique. In the expected difficult intubation group, the success rate was higher (47/50 vs 33/50; p < 0.01), the glottis view was better (Cormack and Lehane 1/2/3/4 grades: 29/17/1/3 vs 5/11/18/16, p < 0.01), mean (SD) intubation time was shorter (45(46) s vs 77(47)s, p < 0.01) and the number of optimising manoeuvres was reduced with the nasotracheal Airtraq compared with the Macintosh, respectively. For difficult nasal intubations, the nasotracheal Airtraq is more effective than the Macintosh laryngoscope.