Anaesthesia
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Comparative Study
Cardiopulmonary exercise testing: arm crank vs cycle ergometry.
This pilot study compared oxygen consumption during arm crank and cycle ergometer tests in 15 women. The mean (SD) peak oxygen consumption was less with arm cranking (25 (5) ml.kg(-1) .min(-1)) than with cycling (40 (7) ml.kg(-1) .min(-1)), p < 0.0001. ⋯ There was moderate correlation, r(2) = 0.60, between the anaerobic thresholds determined by arm and leg exercise, p = 0.0007. This study suggests that arm crank cardiopulmonary exercise testing could be used for pre-operative assessment in those unable to cycle.
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Case Reports
Veno-venous extracorporeal membrane oxygenation (ECMO) support during anaesthesia for oesophagectomy.
The use of extracorporeal membrane oxygenation in adults has increased in popularity and importance for the support of patients with cardiac or pulmonary failure. Although it is now quite commonly used in the intensive care unit, its use has rarely been described as a means of support during anaesthesia and surgery. ⋯ We describe the anaesthetic management of this patient who only had a single lung, review other alternatives and discuss why extracorporeal membrane oxygenation was particularly suited to this case. To the best of our knowledge, the anaesthetic literature to date does not contain a case report of this type.
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Neurological deterioration in a child following routine surgery, although rare, has potentially life threatening consequences. We report the case of a child who, following adentonsillectomy, developed quadriplegia and acute respiratory distress due to previously undetected atlanto-axial instability. Patients with atlanto-axial instability often have mild or non-specific symptoms, despite severe cervical cord compression. Subtle manifestations may be ignored or attributed to other disease processes, which render patients with undiagnosed atlanto-axial instability at risk of serious neurological injury during general anaesthesia, particularly at the time of laryngoscopy and tracheal intubation.
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The General Medical Council is the regulatory body charged with maintaining standards in the medical profession in the UK. We analysed cases relating to anaesthetists handled in 2009 using fitness-to-practise data, comparing them with the profession as a whole and examining patterns of referral. Complaints were made about 105 doctors practising in anaesthesia. ⋯ As with other specialties, allegations were most commonly made about clinical care, probity and relationships with patients. On the basis of 2009 data, we calculated that a mean (95% CI) of 1 in 120 (1 in 100-145) doctors practising in anaesthesia in the UK will be referred to the General Medical Council every year. We have provided examples of allegations and made recommendations for maintaining good practice in anaesthesia.
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Comparative Study
Forces generated by Macintosh and GlideScope® laryngoscopes in four airway-training manikins.
We measured forces generated by Macintosh and GlideScope(®) laryngoscope blades during airway intubation by 16 participants in four manikins: Laerdal(®) SimMan; TruCorp AirSim™ Advance; Laerdal(®) Airway Management Trainer; and Ambu(®) Airway Man. Both laryngoscopes generated the least force in the Laerdal Airway Management Trainer and the most in the Ambu Airway Man. The respective median (IQR [range]) forces generated by the Macintosh blade were 2 (1-4 [1-7]) N vs 9 (7-13 [5-16]) N, p = 0.00004, with peak forces 9 (5-11 [3-16]) N vs 18 (12-22 [3-31]) N, p = 0.0004. The respective average and peak forces generated by the GlideScope blade were 1 (1-2 [0-3]) N vs 4 (3-5 [2-6]) N, p = 0.00001, and 4 (2-7 [0-12]) N vs 7 (4-9 [3-18]) N, p = 0.054.