Anesthesia and analgesia
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We sought to determine the effectiveness of a magnet placed over the thyroid cartilage in the neck to guide an endotracheal tube into the trachea. Forty patients aged 18 to 60 yr with normal airway anatomy (ASA grade I) who required general anesthesia with an endotracheal tube and paralysis for their surgery were chosen and informed consents were obtained. The tip of the epiglottis was exposed with a No. 3 MacIntosh laryngoscope, and a magnet was held over the thyroid cartilage. ⋯ This magnet-guided technique can be used when it is difficult to expose a patient's larynx. It is noninvasive, simple, and can be used without any delay when expensive flexible fiberoptic endoscopes are not readily available. The procedure takes an average of 1 to 2 min.
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Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of methylnaltrexone versus naloxone for reversal of morphine-induced depression of hypoxic ventilatory response.
Methylnaltrexone (MNTX) is a quaternary derivative of naltrexone. It does not cross the blood-brain barrier and, thus, it reverses peripherally mediated effects of morphine without blocking its centrally located analgesic effects. The effects of MNTX on morphine-induced depression of hypoxic ventilatory response are unknown. ⋯ MNTX slope (69%) was not statistically different from the control, whereas VE80 (70%) was still depressed (P < 0.05). Placebo slope and VE80, at 120 min, remained lower than the control (P < 0.05). These data show that MNTX is not as effective as naloxone for reversal of morphine-mediated depression of respiration during acute hypoxia.
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Anesthesia and analgesia · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialThe laryngeal mask airway in pediatric patients: factors affecting ease of use during insertion and emergence.
Use of the laryngeal mask airway (LMA) permits the maintenance of a patent airway with successful insertion rates of the LMA on the first attempt varying between 67%-92% in children. The recommended insertion technique involves deflation of the mask using a syringe, and application of a lubricant jelly. In a randomized study of 122 children, we compared the time to complete LMA insertion, the number of attempts before successful placement, and the occurrence of laryngospasm and Spo2 < 90% during insertion using the standard deflated method and an alternative method of insertion with the LMA cuff partially inflated. ⋯ Insertion of the LMA partially inflated required significantly less time (16 vs 23 s, P < 0.05), and was associated with a higher success rate on first attempts (85.5% vs 96.7%, P < 0.05). In those who did not receive morphine, 2% lidocaine topical solution decreased the incidence of coughing on emergence (10.3% vs 36.4%). The ease of insertion of the LMA in children was improved by partial inflation of the cuff and in addition, 2% lidocaine topical solution was as beneficial as morphine in reducing coughing on emergence.