European journal of anaesthesiology
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Comparative Study
Value of oropharyngeal Mallampati classification in predicting difficult laryngoscopy among obese patients.
The prediction of difficult intubation in obese patients was investigated by co-estimating the degree of visibility of oropharyngeal structures in conjunction with the respective body mass index. Data were collected prospectively in a series of 1833 consecutive adult patients. Body mass index (BMI) in kg m-2 was used as a measure of obesity (morbid: > 40, moderate: 30-40, no obesity: < 30). ⋯ Statistical analysis revealed an increased risk of difficult laryngoscopy among obese patients compared with subjects with normal body mass index (20.2% vs. 7.6%, P < 0.001). When obesity is estimated with respect to oropharyngeal class the positive predictive value is greatly improved (66.7% vs. 20.2%, P < 0.001). We conclude that obesity which is associated with a disproportionately large base of the tongue, is a predisposing factor for difficult laryngoscopy.
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Randomized Controlled Trial Clinical Trial
Effect of diluent volume on post-operative analgesia and sedation produced by epidurally administered midazolam.
We have studied the optimal diluent volume for post-operative analgesia and sedation produced by epidurally administered midazolam after upper abdominal surgery. Sixty patients were randomly allocated to four groups of 15 patients. When patients complained of pain after surgery, epidural midazolam 0.05 mg kg-1 in 3 mL saline (Group A), in 5 mL saline (Group B), in 10 mL saline (Group C) or in 15 mL saline (Group D) were injected as a bolus. ⋯ The interval to the second request for an analgesic was significantly shorter in Group D than in the other three groups. Memory retention of the pin-prick examination was reported by four patients in Group A. The present results indicate that 5-10 mL saline is the optimal volume for epidural injection when using midazolam 0.05 mg kg-1 for post-operative analgesia following upper abdominal surgery.
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A 17-nation survey was undertaken with the aim of studying the availability of acute pain services (APS) and the use of newer analgesic techniques, such as epidural and patient-controlled analgesia (PCA). A questionnaire was mailed to selected anaesthesiologists in 105 European hospitals from 17 countries. Depending on the population, between five and ten representative hospitals from each country were selected by a country coordinator. ⋯ This survey of 105 hospitals from 17 European countries showed that over 50% of anaesthesiologists were dissatisfied with post-operative pain management on surgical wards. Only 34% of hospitals had an organized APS, and very few hospitals used quality assurance measures such as frequent pain assessment and documentation. There is a need to establish organized APS in most hospitals and also a need for clearer definition of the role of anaesthesiologists in such APS.
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A telephone audit was carried out on patients 24 hours after day case surgery. An initial audit shortly after the day case opened indicated pain scores and nausea that were considered unacceptable. ⋯ Only one patient in 111 (0.9%) called their GP out, but nausea scores remained unchanged. Methods to reduce this index are suggested.
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Case Reports
Anaesthetic management for caesarean section combined with removal of phaeochromocytoma.
In this case report, the anaesthetic management for a removal of phaeochromocytoma undertaken immediately following Caesarean section is described. A 32-year-old female patients was given epidural anaesthesia for Caesarean section, and thereafter, general anaesthesia for a resection of phaeochromocytoma. ⋯ A live infant was delivered and the supra-adrenal tumour was excised successfully. The patient's post-operative recovery was uneventful.