Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 2007
Ultrasound quantification of anterior soft tissue thickness fails to predict difficult laryngoscopy in obese patients.
Morbid obesity is associated with difficult laryngoscopy and intubation. In the general population, bedside indices for predicting difficult intubation (i.e. Mallampati classification, thyromental distance, sternomental distance, mouth-opening and Wilson risk score) have poor-to-moderate sensitivity (20-62%) and moderate-to-fair specificity (82-97%). ⋯ Twenty patients were classified as difficult laryngoscopy; they were older (47 +/- 9 vs 42 +/- 1 years; P = 0.048; mean +/- SD) and had less soft pretracheal tissue (20.4 +/- 3.0 vs 22.3 +/- 3.8 mm; P = 0.049) than did easy laryngoscopy patients. Multivariate regression indicated that none of the factors was an independent predictor of difficult laryngoscopy. We conclude that the thickness of pretracheal soft tissue at the level of the vocal cords is not a good predictor of difficult laryngoscopy in obese patients in the United States.
-
Anaesth Intensive Care · Feb 2007
Randomized Controlled TrialThe ProSeal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy.
We tested the hypothesis that the ProSeal laryngeal mask airway is superior to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. One-hundred and eighty consecutive patients (ASA grade 1-2, aged 18-80 y) were divided into two equal-sized groups for airway management with the ProSeal laryngeal mask airway or tracheal tube. Induction was with fentanyl/propofol, maintenance with sevoflurane and muscle relaxation with atracurium. ⋯ The duration of surgery, duration of pneumoperitoneum and intra-abdominal pressures were similar Gastric size was similar at the start and end of surgery. There were no differences in the frequency of complications or sore throat. We conclude that the ProSeal laryngeal mask airway is a similarly effective airway device to conventional laryngoscope-guided tracheal intubation for gynaecological laparoscopy, but is more rapidly inserted and associated with an attenuated haemodynamic response to insertion and removal.
-
Anaesth Intensive Care · Feb 2007
Risks of regional anaesthesia for caesarean section: women's recall and information sources.
Recall and information sources regarding the risks of regional anaesthesia in women having lower segment caesarean section have not been adequately assessed previously. We aimed to survey women's recall of their pre-anaesthesia risk discussion and determine where women, presenting for lower segment caesarean section under regional anaesthesia, obtain risk information. Following a small pilot survey, women's responses were recorded for "spontaneous" or "prompted" recalled risks, the information source and its reliability. ⋯ Of those women giving at least four spontaneous responses, 41 (58.6%) had elective and 26 (32.5%) had emergency lower segment caesarean section (P = 0.001). The majority of women stated that anaesthetists were the main, and most reliable, source of their information regarding risks of regional anaesthesia for caesarean section. This report identifies the risks associated with regional anaesthesia for caesarean section that women most frequently recall, namely headache, paralysis, nerve damage and inadequate block.
-
Anaesth Intensive Care · Feb 2007
Case ReportsDiagnostic dilemmas and management of fulminant myocarditis.
Myocarditis is commonly a diagnosis of exclusion. We report a case of fulminant myocarditis in a patient with cardiogenic shock in whom the initial diagnosis was unclear. ⋯ Complete recovery of cardiac function was achieved. This case highlights the difficulty in diagnosing myocarditis and the benefits of early intensive support.
-
Critically ill patients are often unable to make decisions about life-sustaining treatments and surrogate decision-makers are relied upon. However, it is unclear how accurately the surrogates' decisions reflect patients' intentions and expectations. We interviewed 36 pairs of patients and their appointed surrogate decision-makers about their decisions regarding nine treatments in each of three scenarios. ⋯ The significantly higher surrogate scores suggest that the surrogates' decisions would have resulted in the patients having far more treatment than the patients would have wanted. In our participants, there was poor agreement between the decisions made by surrogates and patients. Further study is needed on measures such as facilitated discussions, advance directives and the difficulties that surrogates face, in order to improve the accuracy of surrogates' decisions and respect of patients' autonomy.