Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2002
Ratio of patient's height to thyromental distance improves prediction of difficult laryngoscopy.
Several tests have been proposed to predict difficult laryngoscopy or intubation. The thyromental distance (TMD) is often used for these purposes but this measurement, used alone, is unreliable. This study tested the hypothesis that the ratio of the patient's height to TMD (ratio of height to TMD = RHTMD) would improve the accuracy of predicting difficult laryngoscopy compared with TMD alone. ⋯ A ratio of 25 for the RHTMD was found to be the optimal cut-off value to predict difficult laryngoscopy. When the sensitivity of both tests was 0.81, the RHTMD had a significantly greater specificity (0.91) than the TMD (0.73). Based on our results, we recommend that the RHTMD should be used instead of the TMD.
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Anaesth Intensive Care · Dec 2002
The impact of intraoperative transoesophageal echocardiography on an unselected cardiac surgical population: a review of 2343 cases.
Although intraoperative transoesophageal echocardiography (TOE) has an established role in the management of some cardiac surgical procedures, there is little data on its impact on coronary artery bypass graft (CABG) cases that are stratified for clinical risk. This is a retrospective review of the surgical impact of intraoperative TOE on 2,343 unselected cardiac cases. The surgical impact of TOE findings were rated E (essential)--resulted in changes to the proposed surgical procedure or V (valuable)--the surgical technique for the planned surgery was altered. ⋯ The commonest E-impact in CABG patients was unscheduled valve surgery (2.6% of high-risk patients). The complication rate attributable to TOE was 0.09%. These findings provide indirect evidence for a potential patient benefit from the routine use of TOE in cardiac surgery.
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Anaesth Intensive Care · Oct 2002
Comparative StudyRemifentanil concentration during target-controlled infusion of propofol.
After institutional approval and with written informed consent, eight surgical patients were infused intravenously with remifentanil at 250 ngkg lean body mass (LBM)(-1) x min(-1) for 30 min. Cardiovascular and respiratory parameters were recorded and arterial blood samples were taken at regular intervals. In each patient, the same protocol was repeated 40 min later during propofol infused to a target concentration of 3.0 microg x ml(-1). ⋯ The median AUC during propofol infusion was greater than control in all subjects, although there was considerable variation of 94.4 (64.3-129.6) versus 64.6 (34.8-126.9) ng x ml(-1) x min; P=0.008, n=8. After 30 min, there was no significant difference in remifentanil concentration during propofol infusion when compared with remifentanil alone of 4.6 (3.2-5.7) versus 3.8 (1.6-4.9) ng x ml(-1); P=0.73, n=8. Co-administration of propofol and remifentanil may result in greater remifentanil concentrations than when remifentanil is infused alone.
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Anaesth Intensive Care · Oct 2002
Case ReportsSystemic air embolism after intercostal chest drain insertion and positive pressure ventilation in chest trauma.
Systemic air embolism is a potentially lethal often unrecognised complication of severe chest trauma. We present a case of delayed diagnosis of cerebral air embolism in a patient with severe thoracic trauma. The initiation of positive pressure ventilation, systemic hypotension, intraparenchymal chest drains and aerial transfer to an intensive care unit were all factors contributing to the development of systemic air embolism. The common clinical features, diagnostic tests and management of systemic air emboli are discussed.