Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2003
Case ReportsAirway rescue with the ProSeal laryngeal mask airway in the intensive care unit.
We report the successful use of the ProSeal laryngeal mask airway for airway rescue in a 41-year-old septic patient who could be neither intubated nor facemask ventilated. In principle, the ProSeal laryngeal mask airway offers advantages over the Classic LMA in this situation.
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Cricoid pressure has been used for over 200 years. During that time, training in the technique has not changed greatly, despite the well-documented potential for complications if performed improperly. Typically, training relies on quantitative or qualitative descriptions such as "firm" pressure, a number of Newtons of force or equivalent force to that causing pain while pressing on the nose. ⋯ One subject maintained pressure in the range of 25 to 35 Newtons for the entire 45 seconds of the first attempt but no subject performed this well on the second attempt. The use of qualitative and quantitative descriptors of the appropriate pressure does not appear useful in the training of the technique of cricoid pressure. Training incorporating force feedback is recommended.
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A case of acute thyroid swelling is reported following intubation of a young woman with a pre-existing small goitre. The thyroid enlargement then distorted the airway, necessitating an emergency thyroidectomy. The application of cricoid pressure was believed to have caused the intrathyroidal bleeding and the complications of cricoid pressure are reviewed.
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Anaesth Intensive Care · Aug 2003
Clinical evaluation of the HemoSonic monitor in cardiac surgical patients in the ICU.
The HemoSonic monitor (HemoSonic 100, Arrow International, Reading, PA, U. S. A.) is a minimally invasive device to determine cardiac output by means of M-mode and pulsed Doppler ultrasound. ⋯ It appears to be less suitable for use in patients with a high cardiac output state. The oesophageal probe is moderately difficult for patients to tolerate and is only appropriate for use in sedated patients. The accuracy of the device is somewhat operator-dependent.