British journal of anaesthesia
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Meta Analysis
Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients.
The modified Mallampati score is used to predict difficult tracheal intubation. We have conducted a meta-analysis of published studies to evaluate the Mallampati score as a prognostic test. A total of 55 studies involving 177 088 patients were included after comprehensive electronic and manual searches. ⋯ Meta-regression analyses did not identify any significant explanation of the heterogeneity. We conclude that the prognostic value of the modified Mallampati score was worse than that estimated by previous meta-analyses. Our assessment shows that the modified Mallampati score is inadequate as a stand-alone test of a difficult laryngoscopy or tracheal intubation, but it may well be a part of a multivariate model for the prediction of a difficult tracheal intubation.
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Randomized Controlled Trial
Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study.
Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA). ⋯ TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.
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Lidocaine with epinephrine is the most optimal solution for epidural top-up for emergency caesarean section. Adding fentanyl further speeds onset.
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Randomized Controlled Trial
Does a postoperative visit increase patient satisfaction with anaesthesia care?
Patient satisfaction with anaesthesia is unchanged by post-operative anaesthetist visit.
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Multicenter Study
Out-of-theatre tracheal intubation: prospective multicentre study of clinical practice and adverse events.
Tracheal intubation is commonly performed outside the operating theatre and is associated with higher risk than intubation in theatre. Recent guidelines and publications including the 4th National Audit Project of the Royal College of Anaesthetists have sought to improve the safety of out-of-theatre intubations. ⋯ Out-of-theatre intubation frequently occurs in the absence of essential safety equipment, despite the existing guidelines. The associated adverse event rate is high.