Articles: anesthesia.
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Multicenter Study
A national census of central neuraxial block in the UK: results of the snapshot phase of the Third National Audit Project of the Royal College of Anaesthetists.
The first stage of the Royal College of Anaesthetists Third National Audit Project to assess the incidence of major complications of central neuraxial block in the UK was a 2-week national census of block use. A reporting system was established in the 309 National Health Service hospitals believed to undertake surgical work and data were received from 304, a response rate of 98.7%. ⋯ The total number of procedures reported as being performed in the 2-week period was 27,533: extrapolation using a multiplier of 25 suggests that nearly 700,000 major blocks are performed annually (315,000 spinals, 287,000 cervical, thoracic or lumbar epidurals, 42,000 combined spinal-epidurals and 56,000 caudal epidurals). After the second stage of the project, which will record complications from the same hospitals over a 12-month period, these data will be used as denominators to calculate the incidences of complications.
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Multicenter Study
The extension of epidural blockade for emergency Caesarean section: a survey of current UK practice.
The conversion of epidural analgesia during labour to surgical anaesthesia for Caesarean section can have important medical and medicolegal implications. This survey sought to establish the current management for extending epidural blockade for emergency Caesarean section. A postal questionnaire was sent to the lead obstetric anaesthetist in all maternity units in the UK (n = 254). ⋯ Of the 161 respondents who commenced anaesthesia in the delivery room, 71% (114) did not monitor the patient during transfer, whilst 87% (140) had ephedrine immediately available. Thirty-three respondents reported a total of 43 adverse incidents associated with the extension of epidural blockade. These included high blocks, inadequate blocks and possible intravascular injections, the latter resulting in two seizures and one cardiac arrest.
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Multicenter Study
Prediction of difficult tracheal intubation in Turkish patients: a multi-center methodological study.
Preoperative evaluation is important in the detection of patients at risk for difficult airway management. It is still unclear whether true prediction is possible and which variables should be chosen for evaluation. The aim of this prospective, multi-centre study was to investigate the incidence of difficult intubation, the sensitivity and positive predictive values of clinical screening tests and whether combining two or more of these tests will improve the prediction of difficult intubation in Turkish patients. ⋯ There is still no individual test or a combination of tests that predict difficult intubations accurately. Tests with higher specificity despite low positive predictive value are needed.
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Multicenter Study
Risk factors of intraoperative oxygen desaturation: a case-control study of 152,314 anesthetics.
The present study was part of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic adverse outcomes. ⋯ Knowing the risk factors of intraoperative oxygen desaturation helps improving personnel to improve preanesthetic conditions and facilitate early detection as well as prompt treatment of intraoperative oxygen desaturation.
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Minerva anestesiologica · Nov 2007
Randomized Controlled Trial Multicenter Study Comparative StudyThe unanticipated difficult intubation: rigid or flexible endoscope?
Unanticipated difficult intubation occurs with a frequency between 1.5% and 8.5%. The aim of this study was to compare the use of flexible versus rigid endoscopy in such a patient population, with respect to the preparation time and feasibility of each device. ⋯ Both endoscopic techniques enable quick and safe intubation. The Bonfils method could be the method of choice in cases of already relaxed patients with unanticipated difficult conventional laryngoscopy, presuming that the anaesthetist is familiar with this technique. Because the clinical re-evaluation for possible predictors of difficult intubation revealed no unknown new factors, the preoperative examination for anatomical peculiarities and being aware are the best protection against unanticipated intubation problems.