British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of intermediate vs subcutaneous cervical plexus block for carotid endarterectomy.
Carotid endarterectomy surgery can be performed under regional anaesthesia alone or under general anaesthesia. However, there are several types of regional block available and reported complication rates after superficial cervical plexus blocks are significantly lower than deep blocks. It is not known if subcutaneous and intermediate blocks are equally effective, although anatomical evidence suggests that the latter (where the injectate diffuses below the deep cervical fascia) might provide superior quality of intraoperative anaesthesia. ⋯ Intermediate and subcutaneous cervical plexus blocks are equally effective for carotid endarterectomy. This study adds to the body of evidence supporting the safe use of superficial blocks for this type of surgery.
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Randomized Controlled Trial
Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone.
This prospective, randomized, observer-blinded study tested the hypothesis that a combined ultrasound-guided block of the infraclavicular brachial plexus plus distal median, radial, and ulnar nerves would accelerate upper extremity anaesthesia compared with infraclavicular block alone. ⋯ ANZCTR: ACTRN12610000155099. https://www.anzctr.org.au/registry/trial_review.aspx?ID=335162.
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Randomized Controlled Trial Comparative Study
Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position.
The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management. The reusable Proseal™ LMA (PLMA) and the single use Supreme™ LMA (SLMA) have been reported to be suitable for this purpose but few comparative data are available. In this study, we compared the clinical use of both devices in adult patients anaesthetized in the prone position. ⋯ Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure.
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This review of the eighth report of the United Kingdom Enquiries into Maternal Deaths, Saving Mothers' Lives, is written primarily for anaesthetists and critical care specialists involved in both maternity and gynaecology services. Direct maternal deaths from systemic sepsis secondary to infection of the genital tract have increased. Systemic sepsis requires early recognition, immediate treatment and multidisciplinary management involving anaesthetists and critical care specialists. ⋯ Airway related problems unfortunately still cause maternal death. The role of early communication between obstetricians and anaesthesia and intensive care specialists is highlighted. The review summarizes the recommendations relating to anaesthesia and intensive care.