Anaesthesia and intensive care
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Laryngeal mask airways (LMA) are commonly used in paediatric anaesthesia. A well-placed LMA should provide a direct view of the vocal cords facilitating bronchoscopy or fibreoptic intubation. The aim of this audit was to assess the bronchoscopic view of the glottis obtained through an LMA with regard to its size. ⋯ The epiglottis impinged on the LMA opening, partially obstructing the view of the glottis in 36.3% of size 1 LMAs, 31.5% of size 1.5, 21% of size 2 and 17.8% of size 2.5. In 13.7% of size 1 LMAs, 11% of size 1.5, 6.3% of size 2 and 4.4% of size 2.5, the epiglottis was completely downfolded, obstructing the view of the glottic aperture. The findings indicate that even if ventilation is judged as adequate, smaller paediatric LMAs are more commonly associated with suboptimal anatomical positioning with partial obstruction of the glottic aperture than larger LMAs, and therefore may require repositioning more often.
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Anaesth Intensive Care · Jan 2010
Case ReportsDifficult double-lumen tube placement due to laryngeal web.
We present a case of difficult intubation in a patient with a laryngeal web. A 33-year-old male patient presented for open thoracotomy and had a previously undiagnosed laryngeal web, which complicated the placement of a double-lumen tube. ⋯ Techniques for managing narrowing of the supraglottic airway are presented and the literature dealing with laryngeal webs is reviewed. In the setting of an unusual airway and thoracic surgery, ventilation via simpler techniques takes precedence over insertion of more complex tubes.
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Anaesth Intensive Care · Jan 2010
Preoperative estimated glomerular filtration rate and RIFLE-classified postoperative acute kidney injury predict length of stay post-coronary bypass surgery in an Australian setting.
We investigated the influence of preoperative estimated glomerular filtration rate and postoperative acute kidney injury on outcomes after coronary bypass surgery in a local setting, with the focus on length of stay. A retrospective analysis of prospectively collected data for 3302 consecutive patients who underwent coronary artery bypass graft surgery (June 1997 through to January 2007) at St. Vincent's Public Hospital, Melbourne, was undertaken. ⋯ Hazard ratios also decreased as severity of postoperative acute kidney injury category increased, when compared to those with no acute kidney injury: risk 0.67 (0.58 to 0.77, P < 0.001), injury 0.52 (0.41 to 0.65, P < 0.001), failure 0.35 (0.20 to 0.60, P < 0.001). The increasing severity of preoperative renal dysfunction and postoperative acute kidney injury were associated with increased hospital length of stay. This has implications for resource use, informed consent and case selection.
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Anaesth Intensive Care · Jan 2010
Effect of the mode of administration of inhaled anaesthetics on the interpretation of the F(A)/F(I) curve--a GasMan simulation.
The effects of blood solubility, cardiac output and ventilation on the rise of the alveolar towards the inspired concentration, the F(A)/F(I) curve, of an inhaled anaesthetic are often thought to reflect how these factors affect wash-in of the central nervous system compartment and, therefore, speed of induction because F(A) is the partial pressure ultimately attained in the central nervous system (F(VRG)). These classical F(A)/F(I) curves assumed a constant F(I). We used GasMan to examine whether changes in solubility, cardiac output and ventilation affect the relationship between the F(A)/F(I) curve and F(VRG) differently while either F(I) or F(A) are kept constant. ⋯ Despite similar effects on the F(A)/F(I) curve, the effects of solubility, cardiac output and ventilation on the F(VRG) are different when either F(I) or F(A) are kept constant. With the F(I) kept constant, induction of anaesthesia is slower with a higher cardiac output, but with F(A) kept constant, induction of anaesthesia is faster with a higher cardiac output. The introduction of an end-expired closed-loop feedback administration of inhaled anaesthetics makes this distinction clinically relevant.
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Anaesth Intensive Care · Jan 2010
Practice patterns for predicted difficult airway management and access to airway equipment by anaesthetists in Queensland, Australia.
A postal survey was conducted to investigate difficult airway management, training and equipment availability among Fellows of the Australian and New Zealand College of Anaesthetists in Queensland. The survey aimed to determine practise patterns for predicted difficult airways and investigate equipment availability. Participants were asked to nominate an induction method, intubation method and airway adjunct for each of the five difficult airway scenarios. ⋯ Difficult intubation trolleys were available to 98% of responders. Certain types of equipment (such as fibreoptic bronchoscopes and cricothyroidotomy kits) were available less frequently in private institutions. We recommend a standardisation of difficult airway management equipment and an on-going training program to provide support for anaesthetists in all locations.