Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study
Laryngoscope manipulation by experienced versus novice laryngoscopists.
During endotracheal intubation using a Macintosh laryngoscope blade, it has been recommended by some that the best laryngeal view is achieved with a laryngoscope handle angle of 45º from horizontal; however, this may be unnecessary. Novices are rarely taught specifically how or where to grip the laryngoscope handle. This study compared the angle and grip of the laryngoscope handle by experienced vs novice laryngoscopists to determine whether basic differences could be identified that might aid in teaching the nuances of skillful laryngoscope manipulation. ⋯ Experienced laryngoscopists used laryngoscope handle angles less than 45º from horizontal for routine intubations. Compared with novices, experts gripped the laryngoscope closer to the hinge and held the laryngoscope more in their fingers vs the palm of their hand. Sharing these important points with novices early in their instruction may improve technique and skill acquisition.
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Letter Randomized Controlled Trial
Association between intrapartum fetal head malrotation and motor block by neuraxial analgesia: a randomized trial.
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Takotsubo cardiomyopathy is characterized by the sudden onset of reversible left ventricular dysfunction. Associated refractory cardiogenic shock is a rare occurrence and may require extracorporeal membrane oxygenation (ECMO). We report a case of a patient who, following the inadvertent injection of 1 mg of epinephrine, presented with reverse Takotsubo cardiomyopathy and refractory cardiogenic shock that required the implementation of a percutaneous ECMO. ⋯ Takotsubo cardiomyopathy following an injection of epinephrine remains a rare but increasingly described occurrence. The severity of the symptoms appears to be patient dependent, but refractory cardiogenic shock may occur and require significant circulatory support. If this situation occurs in a hospital where this necessary equipment is lacking, a mobile ECMO unit appears to be a viable solution to optimize the patient's chances of survival.