Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2002
Clinical TrialBispectral index in assessment of adequacy of general anaesthesia for lower segment caesarean section.
Awareness among parturients during general anaesthesia for caesarean section, though now uncommon, remains a concern for obstetric anaesthetists. We examined the adequacy of our general anaesthetic technique for avoiding explicit awareness by determining the depth of anaesthesia using Bispectral Index (BIS) monitoring. Twenty ASA1 parturients having general anaesthesia for lower segment caesarean section were studied. ⋯ No patient experienced intraoperative dreams, recall or awareness. Our current general anaesthetic technique appeared inadequate to reliably produce BIS values of less than 60 that are associated with a low risk of awareness. However, no patients experienced explicit awareness.
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Anaesth Intensive Care · Feb 2002
Randomized Controlled Trial Clinical TrialDetection and correction of accidental oesophageal intubation during flexible lightwand-guided intubation via the intubating laryngeal mask.
In the following two-part study, we determined the efficacy of observation of the light glow to detect correct placement of the tracheal tube after lightwand-guided tracheal intubation via the intubating laryngeal mask (ILM). We also determined the efficacy of a protocol to correct oesophageal intubation in this situation. In study 1, 80 ASA 1-3, anaesthetized, paralysed patients were randomly assigned to have a tracheal tube, preloaded with a flexible lightwand, placed into either the trachea (n=40) or oesophagus (n=40) under laryngoscope guidance. ⋯ In 40/55 (73%) patients, tracheal intubation was successful at the second attempt and in 13/55 (24%) at the third or fourth attempt. In 2/55 (4%) patients, persistent oesophageal intubation occurred. The sensitivity, specificity and positive predictive value were 95%, 92.5% and 92.7% respectively in study 1, and were all 100% in study 2.
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Anaesth Intensive Care · Feb 2002
Accuracy of portable infusers under hyperbaric oxygenation conditions.
Three types of portable infusers with different infusion mechanisms were evaluated with regard to their accuracy during a hyperbaric oxygenation protocoL The power driving the pump is provided by either a balloon, a spring or a vacuum mechanism. Performance during hyperbaric oxygenation (HBO) varied between the devices, probably due to the difference in driving mechanism. ⋯ We suggest that other devices are more suitable for use in this clinical situation. We conclude that it is desirable to check the performance of any infuser intended for use during hyperbaric oxygenation and to be mindful of potential differences among such devices.
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Anaesth Intensive Care · Feb 2002
The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion.
A prospective cohort study was undertaken to describe the natural history of the cubital fossa peripherally inserted central catheter (PICC), determine which factors influenced the hazard of complication and develop a standard methodology for evaluation of a PICC service. A total of 4349 patient days of PICC observation were analysed using survival analysis techniques. The median time to PICC removal for a complication was 60 days. ⋯ Size 3 French gauge catheters had a complication rate of 7.3 per 1,000 line days compared to 14.2 for 4 French catheters (hazard rate 1.26 90% CI 1.02 to 1.55). PICCs requiring two or more attempts at insertion were more likely to develop complications than those inserted at the first attempt: 20 per 1,000 line days vs 10.5 but the confidence intervals were wide (hazard rate 1.91, 90% CI 0.90 to 4.05). Operator (amongst the four experienced operators who inserted all PICCs), arm of placement, or medial or lateral placement in the cubitalfossa did not influence PICC survivaL
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Anaesth Intensive Care · Feb 2002
The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population.
The use of a modified Cormack-Lehane scoring system (MCLS) of laryngoscopic views, as previously introduced in the Western population, was investigated during direct laryngoscopy in the Asian population. We studied the distribution of the different grades of MCLS, the predictive factors and rate of difficult laryngoscopy, and the association with difficult intubation. Six hundred and five patients requiring tracheal intubation during general anaesthesia were prospectively studied. ⋯ The rates of difficult laryngoscopy and intubation were 5.1% and 6.9% respectively. The Mallampati classification and thyromental distance were associated with low predictive value for difficult laryngoscopy. The MCLS better delineates the difficulty experienced during laryngoscopy than the original Cormack-Lehane grading