Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialThe intubating laryngeal mask airway: effect of handle elevation on efficacy of seal, fibreoptic position, blind intubation and airway protection.
We conducted three studies to test the hypothesis that elevation of the intubating laryngeal mask (ILM) handle increases efficacy of seal, changes fibreoptic position, prevents aspiration of regurgitated fluid and improves intubation. In study 1, the ILM was inserted into 20 paralysed, anaesthetized patients and 20 cadavers. Oropharyngeal leak pressure and fibreoptic position were measured at an intracuff pressure of 0, 60 and 120 cm H2O with 0, 20 and 40 N of elevation force. ⋯ Aspiration and regurgitation usually occurred at the same oesophageal pressure. In study 3, blind intubation was more successful at 0 N than 40 N (15/20 v 8/20, P = 0.03). We conclude that elevation of the ILM handle has little clinical utility other than as a temporary measure to improve the efficacy of the seal.
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Anaesth Intensive Care · Aug 2000
Comparative StudyAgreement between two plasma bicarbonate assays in critically ill patients.
Previous studies have suggested that measurement of plasma bicarbonate concentration using the Henderson-Hasselbalch equation may be unreliable, particularly in critically ill patients. We examined the agreement between two plasma bicarbonate concentration assays in critically ill patients. Data were collected from records of routine daily blood samples. ⋯ This study found poor agreement between the two bicarbonate assays. This poor agreement is clinically important but the causes are unclear. We suggest further investigation of the reliability of bicarbonate assays.
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Anaesth Intensive Care · Aug 2000
Case ReportsTracheal foreign body following tube change during percutaneous dilational tracheostomy: a cautionary tale.
Although studies have shown percutaneous dilational tracheostomy to be a safe and cost-effective alternative to conventional surgical tracheostomy, there are inherent risks and complications. We report an incident occurring during percutaneous dilational tracheostomy using the Portex technique, in which a significant cuff leak occurring on insertion of the tracheostomy tube necessitated an immediate tube change. During this latter procedure, using a fresh Portex kit and guidewire, the guidewire introducer became dislodged from the guidewire assembly and inadvertently impacted in the trachea. Routine bronchoscopy identified the hazard and the foreign body was successfully removed via the bronchoscope with no adverse sequelae.
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The treatment of severe tetanus generally requires prolonged mechanical ventilation. We describe two cases managed with continuous intrathecal infusion of baclofen via a subcutaneous tunnelled spinal catheter and an abdominal injection port. ⋯ Complications include sedation, hypotension and CSF infection. After appropriate dose adjustment, baclofen improves the management of severe tetanus.
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Anaesth Intensive Care · Aug 2000
Prediction of the mediastinal drainage after coronary artery bypass surgery.
Using multiple correlation and linear regression approaches, we investigated the association between the amount of mediastinal drainage for the first 24 postoperative hours and clinical variables as well as multiple haematological tests performed at three time points: before anaesthesia induction, 10 minutes after protamine administration and just after skin closure, on 46 patients undergoing primary coronary artery bypass grafting. Three models from the three times were then developed to predict mediastinal drainage. ⋯ Each regression model explained approximately 60% of the variation in postoperative mediastinal drainage. The information obtained from these predictive models is useful in defining high-risk populations.