Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2009
Comparative StudyThe influence of gender and experience on intubation ability and technique: a manikin study.
Female anaesthetists in early training commonly question whether their strength is adequate for tracheal intubation. This study investigated the influence of gender and experience on intubation ability and laryngoscopic technique. A manikin model and purpose-designed force-transducing laryngoscope was used to test three cohorts at different levels of experience (novice, intermediate and experienced males and females, n = 65) for the axial force and torque exerted, best laryngoscopic view obtained, success with and time for intubation and laryngoscopic technique. ⋯ With experience, the forces generated during intubation reduced and ability improved. Proximal laryngoscope grips (close to the blade) generated lower forces than distal grips. Female and male intubators did not differ in ability to intubate or in the forces they exerted during direct laryngoscopy.
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Anaesth Intensive Care · Sep 2009
Randomized Controlled Trial Comparative StudyComparison of the single-use LMA supreme with the reusable ProSeal LMA for anaesthesia in gynaecological laparoscopic surgery.
The Laryngeal Mask Airway Supreme (LMAS) is a new, single-use laryngeal mask airway with gastric access. We conducted a randomised controlled study comparing the LMAS with the reusable ProSeal Laryngeal Mask Airway (PLMA) in 70 patients undergoing general anaesthesia with paralysis for gynaecological laparoscopic surgery. Our primary outcome measure was the oropharynegal leak pressure. ⋯ We found that after 60 minutes the cuff pressure was significantly higher in the PLMA (110 +/- 21 vs 57 +/- 8 cmH2O, P < 0.001). There was no difference in the ability to provide adequate ventilation and oxygenation during anaesthesia. Complication rates were similar We conclude that the oropharyngeal leak pressure and the maximum achievable tidal volume are lower with the LMAS than with the PLMA.
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Anaesth Intensive Care · Sep 2009
Randomized Controlled TrialEffect of pump prime on acidosis, strong-ion-difference and unmeasured ions during cardiopulmonary bypass.
We tested the hypothesis that a cardiopulmonary bypass prime with lactate would be associated with less acidosis than a prime with only chloride anions because of differences in the measured strong-ion-difference. We randomised 20 patients to a 1500 ml bypass prime with either a chloride-only solution (Ringer's Injection; anions: chloride 152 mmol/l) or a lactated solution (Hartmann's solution; anions: chloride 109 mmol/l, lactate 29 mmol/l). Arterial blood was sampled before bypass and then two, five, 15 and 30 minutes after initiating bypass. ⋯ There was, however a difference in the net-unmeasured-ions (strong-ion-gap). We conclude that acid-base changes with cardiopulmonary bypass may differ with the prime but that the early differences between chloride-only and lactated primes appear not to be due to differences in the measured strong-ion-difference. We suggest future studies examine other possible mechanisms including unmeasured ions.
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Anaesth Intensive Care · Sep 2009
Randomized Controlled Trial Comparative StudyComparison between the effects of propofol and etomidate on motor and electroencephalogram seizure duration during electroconvulsive therapy.
An ideal anaesthetic for electroconvulsive therapy (ECT) should have rapid onset and offset with no effect on seizure duration, and provide cardiovascular stability during the procedure. Propofol is commonly used, even though it has been shown to shorten seizure duration which might affect the efficacy of ECT Etomidate has been advocated as an alternative. This prospective, randomised, single-blind, crossover study was conducted to compare the effects of etomidate (Etomidate-Lipuro, B. ⋯ Etomidate was associated with a significantly longer motor and electroencephalogram seizure duration compared with propofol (P < 0.01). Neither drug demonstrated consistent effects in suppressing the rise in heart rate or blood pressure during ECT Myoclonus and pain on injection were the most common adverse effects in etomidate group and propofol group respectively. Etomidate is a useful anaesthetic agent for ECT and should be considered in patients with inadequate seizure duration with propofol.
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Anaesth Intensive Care · Sep 2009
Comparative StudyMortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital.
Mortality and cost outcomes of elderly intensive care unit (ICU) trauma patients were characterised in a retrospective cohort study from an Australian tertiary ICU Trauma patients admitted between January 2000 and December 2005 were grouped into three major age categories: aged > or =65 years admitted into ICU (n = 272); aged -65 years admitted into general ward (n = 610) and aged < 65 years admitted into ICU (n = 1617). Hospital mortality predictors were characterised as odds ratios (OR) using logistic regression. The impact of predictor variables on (log) total hospital-stay costs was determined using least squares regression. ⋯ Mortality cost-effect was estimated at -63% by least squares regression and -82% by treatment-effects regression model. Patient demographic factors, injury severity and its consequences predict both cost and survival in trauma. The cost mortality effect was biased upwards by conventional least squares regression estimation.