European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with video-assisted blade laryngoscopy and the GlideScope.
We investigated whether the use of two different video laryngoscopes [direct-coupled interface (DCI) video laryngoscope and GlideScope] may improve laryngoscopic view and intubation success compared with the conventional direct Macintosh laryngoscope (direct laryngoscopy) in patients with a predicted difficult airway. ⋯ We conclude that the video laryngoscope and GlideScope in particular may be useful instruments in the management of the predicted difficult airway.
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Randomized Controlled Trial
The usefulness of the laryngeal mask airway Fastrach for laryngeal surgery.
Suspension laryngoscopy under general anaesthesia with a tracheal tube has been widely used for laryngeal microsurgery, but it has some limitations such as intense cardiovascular stimulation during anaesthesia of short duration, occasionally a poor surgical field, and the possibility of a mass being hampered by the tracheal tube. The aim of this study was to compare the usefulness of the laryngeal mask airway (LMA) Fastrach and fibreoptic bronchoscope with a conventional suspension laryngoscope in laryngeal microsurgery. ⋯ The LMA Fastrach during fibreoptic bronchoscope-guided laryngeal surgery provided a good surgical field and haemodynamic stability without additional risk compared with the conventional suspension laryngoscope.
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Randomized Controlled Trial
The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation.
Dexmedetomidine is characterized with effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, it should be suitable for awake fibreoptic intubation (AFOI). ⋯ Combination of dexmedetomidine loading with topical anaesthesia provides significant benefit for AFOI in intubation condition, patient tolerance, haemodynamic response, amnesia and satisfaction. Dexmedetomidine is effective for AFOI in anticipated difficult airway with only minor and temporary haemodynamic adverse effects.
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A new minimally invasive metabolic test for the diagnosis of susceptibility for malignant hyperthermia measuring intramuscular p(CO(2)) and lactate following local application of caffeine and halothane in humans was recently proposed. The present study tested the hypothesis that a more simplified test protocol allows a differentiation between malignant hyperthermia susceptible (MHS) and malignant hyperthermia nonsusceptible (MHN) and control individuals. ⋯ Local caffeine and halothane injection increased intramuscular metabolism in MHS individuals significantly more than in the two other groups. In contrast to previous investigations, direct injection of the concentrations of halothane described here increased lactate and p(CO(2)) even in MHN skeletal muscle.
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Patients commonly take a combination of prescription drugs and herbal medicines. Often these alternative products have known pharmacological effects which may interact with drugs given perioperatively, resulting in adverse events. They can also cause physiological fluctuations which may influence the choice of anaesthetic technique used. This has been acknowledged by a number of national bodies that recommend eliciting a history of herbal medicine use preoperatively. This survey attempted to ascertain whether this guidance had been observed and turned into local policy. We also attempted to determine what advice patients were being given. ⋯ Anaesthetic departments in the United Kingdom are not currently following national advice regarding herbal medicine use. There is no coherence in the advice being offered to patients in the perioperative period, which may reflect the lack of information available. National guidelines may help clinicians understand the issues and adopt best practice.