Anaesthesia
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Randomized Controlled Trial Comparative Study
Cadaveric study of movement of an unstable atlanto-axial (C1/C2) cervical segment during laryngoscopy and intubation using the Airtraq(®) , Macintosh and McCoy laryngoscopes.
Concern that laryngoscopy and intubation might create or exacerbate a spinal cord injury has generated extensive research into cervical spinal movement during laryngoscopy. We performed a randomised trial on six cadavers, using three different laryngoscopes, before and after creating a type-2 odontoid peg fracture. ⋯ Tracheal intubation was performed using a minimal view of the glottis, a bougie, and manual in-line stabilisation. In a cadaveric model of type-2 odontoid fracture, the space available for the cord was preserved in maximum flexion and extension, and changed little on laryngoscopy and intubation.
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Multicenter Study Observational Study
Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study.
The aim of this prospective, double-centre, observational study performed in 116 patients was to describe a new anterior approach of ultrasound-guided intermediate cervical plexus block for carotid endarterectomy. The median (IQR [range]) volume of ropivacaine 0.5% administered was 30 (25-30 [20-45]) ml. Supplemental local anaesthesia (infiltration and topical) was needed in 66 (57%) patients. ⋯ Adverse effects were of short duration and did not affect surgery. Satisfaction scores were high for 92 (79%) patients (63 satisfied; 29 very satisfied) and 104 (90%) surgeons (51 satisfied; 53 very satisfied). This study shows that the ultrasound-guided intermediate cervical plexus block using an anterior approach is feasible and provides similar results to other regional techniques during carotid endarterectomy.
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We performed a prospective, randomised study to evaluate the echogenicity of 11 regional block needles when inserted into a gel phantom at 45° in the ultrasound plane. Two hundred anaesthetists viewed in random sequence recordings of each needle as it was advanced into the phantom. ⋯ The mean (95% CI) echogenicity score was 1.7 (1.4-2.0) units higher for three needles marketed as 'hyperechoic' compared with standard needles marketed by the same companies, p < 0.001. The odds ratios (95% CI) that an anaesthetist would categorise a needle as hyperechoic were: 5.3 (3.6-8.0) if the needle was marketed as hyperechoic, p < 0.001; and 1.7 (1.1-2.6) if regional anaesthetic experience was ≥ 1 year compared with < 1 year, p = 0.025.