Anaesthesia
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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.
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Randomized Controlled Trial Comparative Study
Fibreoptic vs videolaryngoscopic (C-MAC(®) D-BLADE) nasal awake intubation under local anaesthesia.
Numerous indirect laryngoscopes have been introduced into clinical practice and their use for tracheal intubation under local anaesthesia has been described. However, a study comparing indirect laryngoscopic vs fibreoptic intubation under local anaesthesia and sedation appears lacking. Therefore, we evaluated both techniques in 100 patients with an anticipated difficult nasal intubation time for intubation the primary outcome. ⋯ The median (IQR [range]) time for intubation was significantly shorter with the videolaryngoscope with 38 (24-65 [11-420]) s vs 94 (48-323 [19-1020]) s (p < 0.0001). There was no difference in the success rate of intubation (96% for both techniques; p > 0.9999) and satisfaction of the anaesthetists and patients. We conclude that in anticipated difficult nasal intubation a videolaryngoscope represents an acceptable alternative to fibreoptic intubation.
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Randomized Controlled Trial Comparative Study
A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging.
Emergence delirium is a significant problem in children regaining consciousness following general anaesthesia. We compared the emergence characteristics of 120 patients randomly assigned to receive a single intravenous dose of dexmedetomidine 0.3 μg.kg(-1) , propofol 1 mg.kg(-1) , or 10 ml saline 0.9% before emerging from general anaesthesia following a magnetic resonance imaging scan. Emergence delirium was diagnosed as a score of 10 or more on the Paediatric Anaesthesia Emergence Delirium scale. ⋯ Three patients in the dexmedetomidine group, none in the propofol group and two in the saline group required pharmacological intervention for emergence delirium (p = 0.202). Administration of neither dexmedetomidine nor propofol significantly reduced the incidence, or severity, of emergence delirium. The only significant predictor for emergence delirium was the time taken to awaken from general anaesthesia, with every minute increase in wake-up time reducing the odds of emergence delirium by 7%.
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Randomized Controlled Trial
The effects of Patent Blue dye on peripheral and cerebral oxyhaemoglobin saturations.
We measured the effect of Patent Blue dye on oxyhaemoglobin saturations after injection into breast tissue: 40 women had anaesthesia for breast surgery maintained with sevoflurane or propofol (20 randomly allocated to each). Saturations were recorded with a digital pulse oximeter, in arterial blood samples and with a cerebral tissue oximeter before dye injection and 10, 20, 30, 40, 50, 60, 75, 90, 105 and 120 min afterwards. ⋯ The falsely reduced oximeter readings persisted for at least 2 h. The mean (SD) intra-operative digital pulse oxyhaemoglobin readings were lower with sevoflurane than propofol, 97.8 (1.2) % and 98.8 (1.0) %, respectively, p < 0.0001.
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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.