Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2000
Comparative StudyRoutine blood test ordering for patients in intensive care.
Current practice is for a number of blood tests to be routinely performed on intensive care unit (ICU) patients. A survey of routine blood testing amongst ICUs in Australia and New Zealand was conducted. Ninety-six ICUs completed the survey form. ⋯ Routine blood testing was not practised in 12.6% of ICUs. The presence or absence of written guidelines did not influence the frequency of the most commonly performed routine blood tests. Clinical and operational factors specific to each ICU appear to impact on such blood tests and guidelines for their use.
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Anaesth Intensive Care · Oct 2000
Comparative Study Clinical TrialThe McCoy laryngoscope, external laryngeal pressure, and their combined use.
The efficacy of the McCoy laryngoscope, external laryngeal pressure, and their combination to improve the laryngoscopic view was evaluated in 219 patients and compared with the Macintosh laryngoscope. An experienced laryngoscopist performed laryngoscopy twice using the Macintosh laryngoscope and the McCoy laryngoscope in a random sequence, and external laryngeal pressure was applied in each laryngoscopy with the laryngoscopist's right hand. ⋯ Without external laryngeal pressure, the McCoy laryngoscope provided a better laryngoscopic view than that obtained by the Macintosh laryngoscope (P < 0.001, signed rank test), but the view was worse than that with the Macintosh laryngoscope under external laryngeal pressure (P < 0.001). The McCoy laryngoscope combined with external laryngeal pressure provided a better view than the Macintosh laryngoscope with external laryngeal pressure (P < 0.001).
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This study examined the efficacy of a technique of administration of lignocaine 2% (with 1:200,000 adrenaline) to the nose, pharynx and larynx. A simple device constructed from a 22 gauge Optiva cannula attached to a medical oxygen supply via green "bubble" tubing and the barrel of a 3 ml syringe, similar to that described by Mackenzie, was used to administer aerosolized lignocaine initially via the nose and subsequently via a nasopharyngeal airway. Ten unsedated, unpremedicated volunteers were intubated. ⋯ Intubating conditions were good and the procedure was well tolerated in all subjects. The mean dose of lignocaine was 4.8 mg.kg-1 (range 2.7 to 6.9 mg.kg-1) and plasma concentrations were well below toxic levels (highest concentration 3.12 mg.l-1). There was good haemodynamic stability and no episode of oxyhaemoglobin desaturation.
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Anaesth Intensive Care · Oct 2000
Sevoflurane output from the Oxford Miniature Vaporizer in drawover mode.
The sevoflurane output from the Oxford Miniature Vaporizer (OMV) was measured in a series of bench tests in a drawover system. Using a range of settings on two OMVs in series, output ranged from 0.5 to 5.9% with a 600 ml tidal volume at a rate of 12 breaths/min produced by a Penlon Multivent. The OMVs' output was steady over 40 minutes. ⋯ When continuous flow of carrier gas at 7.2 l/min was used, the output was lower than at the equivalent intermittent flow rate. Using two OMVs with a drawover system appears to be a feasible technique for the induction and maintenance of sevoflurane anaesthesia. Clinical tests of sevoflurane drawover anaesthesia are now required so that the advantages of sevoflurane can gain wider application in field and military anaesthesia.
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Anaesth Intensive Care · Oct 2000
Use of a fibreoptic stylet to visually evaluate tracheal intubation technique.
To compare the tracheal intubation by novices with that of instructors, we videotaped the view obtained through a fibreoptic stylet during standard tracheal intubations with a Macintosh direct laryngoscope. The duration of visualization of the vocal cords was longer during intubation by instructors than during trainee attempts. ⋯ The quality of the image of the vocal cords through the stylet was related to these video-view parameters. Our results demonstrated that visualization of the vocal cords by direct laryngoscope and manipulation of the tracheal tube in the oral cavity were different between anaesthesia trainees and instructors, and suggested that visually monitoring the tracheal intubation procedure through a fibreoptic stylet might be useful for the education of anaesthesia trainees.