European journal of anaesthesiology
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Comment Letter
Meta-analysis: the importance of a proper search strategy.
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Unexpected difficulty in tracheal intubation is an intermittent and often terrifying problem for all practising anaesthetists. There are many preoperative assessment tests to predict a difficult laryngeal view or a difficult intubation, but we found no published evidence of how frequently these predictive tests are used or how useful they are perceived to be by anaesthetists. ⋯ These results are a cause for concern with regard to both airway management training and patient safety.
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Randomized Controlled Trial Multicenter Study Comparative Study
Effects of four different positive airway pressures on right internal jugular vein catheterisation.
The right internal jugular vein (RIJV) is often used for central venous catheterisation in patients undergoing major surgery. The efficacy of this route correlates with the diameter of the vein which can be influenced by airway pressure. ⋯ A PAP of 20 cmH2O seems most suitable for successful RIJV catheterisation in mechanically ventilated patients. It is associated with an increase in cross-sectional RIJV area and CVP, which facilitate cannulation, and results in fewer puncture-related complications. However, meticulous haemodynamic monitoring is needed to avoid hypotension and bradycardia.
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Difficulty during tracheal intubation is the most common cause of serious adverse respiratory events for patients undergoing anaesthesia. Current traditional bedside predictors of difficult laryngoscopy have poor sensitivity. A simple method to accurately predict difficult laryngoscopy could greatly improve patient safety. ⋯ Although our novel measurement performed similarly to traditional bedside predictors of difficult laryngoscopy, the sensitivity was too low for the test to be clinically useful. Numerous factors which may be very difficult to predict at the bedside probably contributed to the poor performance of this novel measurement.