Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2001
Randomized Controlled Trial Comparative Study Clinical TrialA randomized trial comparing two laryngeal mask airway insertion techniques.
This study was undertaken to compare laryngoscopic-guided LMA insertion with a standard insertion technique. A total of 149 patients undergoing elective general surgical and orthopaedic procedures were randomly divided into two groups. ⋯ There were no statistically significant differences found. The laryngoscope may aid laryngeal mask airway insertion in some circumstances.
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Anaesth Intensive Care · Dec 2001
Randomized Controlled Trial Comparative Study Clinical TrialLaryngeal mask vs intubating laryngeal mask: insertion and ventilation by inexperienced resuscitators.
The laryngeal mask airway (LMA) has been shown to be useful in airway maintenance during resuscitation. The intubating laryngeal mask (ILM) is a modified LMA permitting both ventilation and rapid endotracheal intubation. We aimed to compare the LMA and the ILM with regard to ease of insertion and successful ventilation by inexperienced personnel. ⋯ Reasons for failure included inability to insert the ILM past the teeth and insertion of the LMA upside down. There were no clinically relevant differences in the mean time to airway insertion and successful ventilation (62.6 vs 62 seconds) or expired tidal volume (781 vs 767 ml) for the LMA and ILM respectively. We conclude that the ILM is as easily inserted and effectively used as an LMA by novices and, because it allows the option offacilitating endotracheal intubation, may be the preferred device for maintaining an airway during resuscitation.
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Anaesth Intensive Care · Dec 2001
Comparative StudyComparison of three methods to estimate plasma bicarbonate in critically ill patients: Henderson-Hasselbalch, enzymatic, and strong-ion-gap.
We have previously found poor agreement between Henderson-Hasselbalch and enzymatic methods for estimating plasma bicarbonate concentration in critically ill patients. In this study we compared these two established methods with a new method for estimating bicarbonate using the strong-ion-gap equation. The strong-ion-gap is derived from the Stewart approach to acid-base physiology. ⋯ Comparing the enzymatic to the strong-ion-gap method, the bias was -11.2 mmol/l and the limits of agreement were -18.2 mmol/l to -4.2 mmol/l. This study found poor agreement between the two established bicarbonate assays and worse agreement between the established assays and the strong-ion-gap method. The strong-ion-gap method is currently too inaccurate for clinical application, but may have future use.
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Anaesth Intensive Care · Dec 2001
Enteral nutrition in the critically ill: a prospective survey in an Australian intensive care unit.
Nutritional support is routine practice in critically ill patients and enteral feeding is preferred to the parenteral route. However this direct delivery of nutrients to the gut is potentially ineffective for a variety of reasons. We performed a prospective audit of 40 consecutive intensive care patients to determine whether enteral feeding met the nutritional requirements of our patients. ⋯ Success of feeding was not related to the use of sedative orparalysing agents and had no correlation with plasma albumin concentration. There was no difference in the volume of feed delivered to patients who survived or died. Prokinetic agents were used in 25 patients and in these patients there was a trend towards improved delivery of feed.
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A Macintosh laryngoscope was modified to allow a rigid fibreoptic scope to be attached. Our purpose was to determine if Cormack and Lehane scores could be improved using the described fibreoptic technique, thus allowing easier intubating conditions. In order to assess its value for intubation, a study was performed on 53 patients. ⋯ The Cormack and Lehane scores were improved by the use of the modified laryngoscope by one to three grades compared to the standard laryngoscopy. Significantly improved intubating condition were observed. The assessment demonstrates that many patients with Mallampati scores of III and IV can be successfully managed by this technique.