Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2012
The self-pressurising air-Q® Intubating Laryngeal Airway for airway maintenance during anaesthesia in adults: a report of the first 100 uses.
The self-pressurising air-Q® Intubating Laryngeal Airway is a new, commercially available, supraglottic airway device that incorporates a self-regulating periglottic cuff. In this retrospective review, we describe our initial clinical experience using the device in 100 patients. The ease and number of insertion attempts, airway seal pressure, device positioning, intubation success and oropharyngeal morbidity were recorded. ⋯ Eleven percent of patients complained of sore throat postoperatively before discharge. In our series, the air-Q Intubating Laryngeal Airway performed adequately as a primary airway during anaesthesia with respect to ease of insertion, adequacy of airway maintenance and as a conduit for intubation in both anticipated and unanticipated difficult airways. Although our initial experience is positive, further investigation with larger numbers of observations are needed as the upper limits of the 95% confidence intervals for device failure (the worst failure rate the clinician could expect) are still high.
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Anaesth Intensive Care · Nov 2012
Randomized Controlled Trial Comparative StudyA pilot study of cerebral and haemodynamic physiological changes during sedation with dexmedetomidine or propofol in patients with acute brain injury.
Sedation for the mechanically-ventilated, brain-injured patient remains challenging. The purpose of this pilot study was to compare the cerebral physiologic effects of sedation with propofol versus dexmedetomidine in mechanically-ventilated, brain-injured patients. Using a randomised, crossover, unblinded clinical trial, we enrolled patients with severe brain injury (Glasgow Coma Score ≤8) from traumatic injury, subarachnoid haemorrhage or intracerebral haemorrhage undergoing multimodal monitoring (intracranial pressure, brain temperature, oximetry and microdialysis). ⋯ Though differences were noted in cerebral metabolic substrates (lactate/pyruvate ratio), none were statistically significant. In our pilot cohort, dexmedetomidine and propofol appear equally effective in sedating severely brain-injured patients and neither is associated with adverse physiological effects as measured by multimodal monitoring. Larger long-term studies are required to determine whether clinically favourable benefits demonstrated in the medical critical care setting also apply to this patient population.