Anaesthesia
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Randomized Controlled Trial
Stylet- or forceps-guided tube exchanger to facilitate GlideScope intubation in simulated difficult intubations--a randomised controlled trial.
The GlideScope videolaryngoscope is widely used in the management of the difficult airway. However, passing the tracheal tube through the vocal cords can be awkward, and the use of a stylet to guide insertion is recommended. This randomised controlled trial evaluated a forceps-guided tube exchanger as an alternative to the stylet to aid intubation with the GlideScope in patients undergoing anaesthesia, with a simulated difficult airway created by the application of a semi-rigid cervical collar. ⋯ The mean (SD) intubation time was 67.8 (28.7) s in the stylet group and 66.1 (15.5) s in the forceps-guided tube exchanger group (p = 0.11). The frequency of sore throat 1 h after extubation was 34.1% in the stylet group and 2.2% in the tube exchanger group (p < 0.001); 24 h after extubation the corresponding figures were 40.0% and 11.1% (p < 0.001). Using a forceps-guided tube exchanger may offer an advantage over a stylet in guiding tracheal intubation when the GlideScope is used.
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We investigated whether the type of anaesthesia affects mortality and length of stay after non-traumatic major lower extremity amputations. A total of 1365 eligible patients who were operated on between 2002 and 2010 were included in the final analysis. ⋯ The median (IQR [range]) length of postoperative hospital stay was significantly less in the patients of the high-risk subgroup who had general anaesthesia at 15 (7-21 [1-101]) days compared with 25 days (10-37 [0-78]) for those who had regional anaesthesia (p = 0.027). The results of our study suggest that 30-day mortality is significantly higher in patients undergoing major lower extremity amputations under general anaesthesia compared with regional anaesthesia.
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Various studies have implicated a potential association between candidate gene polymorphisms and postoperative cognitive dysfunction, yet corroborative studies are lacking. We investigated the variants in genes encoding platelet glycoprotein-IIIa and apolipoprotein-E and their relationship with postoperative cognitive dysfunction one year after cardiac surgery. A total of 155 patients were studied; neuropsychological testing demonstrated cognitive dysfunction in 31 (20%) patients at one-year follow-up. ⋯ The apolipoprotein E-ε4 allele was present in 9 (29%) and 24 (19%) patients with and without cognitive dysfunction, respectively, p = 0.24. Both the Pl(A2) and apolipoprotein-ε4 alleles were present together in 6 (19%) and 5 (4%) patients with and without cognitive dysfunction, respectively, p = 0.003. Validation of these findings is required in age-adjusted non-surgical controls.