Anaesthesia and intensive care
-
Anaesth Intensive Care · Oct 2005
Case ReportsDifficult intubation managed using standard laryngeal mask airway, flexible fibreoptic bronchoscope and wire guided enteral feeding tube.
This case report describes an alternative method of achieving trans-oral intubation in a patient with a difficult airway who was apnoeic secondary to the therapeutic administration of a non-depolarizing neuromuscular blocking drug given to aid laryngoscopy. After attempts to intubate were unsuccessful by means of direct laryngoscopy utilizing various aids including bougies, a standard laryngeal mask airway was used to ventilate the patient and subsequently, with a swivel Y-connector attached in order to maintain PEEP, to aid the passage of a bronchoscope. ⋯ The technique described permitted the continuous application of positive airway pressure, which dramatically improved the bronchoscopic view during the crucial step of placing the guide-wire into the trachea. Passing the feeding tube over the guide-wire aided the subsequent passage of the endotracheal tube, by acting as a stiffer and larger diameter guide through the glottis.
-
Anaesth Intensive Care · Oct 2005
An audit of morphine versus fentanyl as an adjunct to ropivacaine 0.2% for high thoracic epidural analgesia.
When used as an adjunct to local anaesthetic, opioid administered via the epidural route can improve the quality of analgesia. Reports of respiratory depression associated with epidural morphine use as a sole agent in the 1980s led to an increased use of lipophilic opioids, especially fentanyl. Although fentanyl is commonly used, controversy exists about its efficacy and site of action. ⋯ There were no significant differences between the groups for sedation scores or the incidence of respiratory depression. This audit suggests morphine 20 microg/ml may be superior to fentanyl 2 microg/ml, as an adjunct to 0.2% ropivacaine. We found a reduced number of infusion interventions and less inadequate patient analgesia.