Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Which induction drug for cesarean section? A comparison of thiopental sodium, propofol, and midazolam.
To determine maternal and neonatal effects of three different induction drugs (thiopental sodium, propofol, and midazolam) for cesarean section. ⋯ Thiopental still remains the first-choice induction drug for cesarean section. The slow induction time with midazolam may put the mother at risk for pulmonary inhalation. A plane of anesthesia that may risk awareness and potential neonatal depression is the main drawback of the two newer induction drugs.
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Randomized Controlled Trial Clinical Trial
The laryngeal lift: a method to facilitate endotracheal intubation.
To assess the efficacy of the "laryngeal lift" maneuver in improving laryngoscopic visualization to facilitate endotracheal intubation. ⋯ The laryngeal lift should be part of the anesthesiologists' armamentarium in helping the laryngoscopist who is faced with Grades II, III, IV, and V laryngoscopic views to enhance visualization of the larynx and thus facilitate endotracheal intubation.
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Randomized Controlled Trial Clinical Trial
Using the bubble inclinometer to measure laryngeal tilt and predict difficulty of laryngoscopy.
To evaluate a simple device, the bubble inclinometer, to measure degrees of laryngeal tilt (LT) for predicting difficulty of direct laryngoscopy using a Macintosh #3 laryngoscope. ⋯ The bubble inclinometer accurately and reproducibly measures relative LT, and the anterior tilt of the larynx directly correlates with the ability to see the laryngeal opening during direct laryngoscopy with a Macintosh #3 laryngoscope.
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Pregnancy carries substantial maternal and fetal risks in patients with uncorrected or palliatively corrected cyanotic congenital heart disease (CHD). In tricuspid valve Ebstein's anomaly, pregnancy is well tolerated. Maternal mortality in tetralogy of Fallot seems to be less than 10%, but it exceeds 50% in Eisenmenger's syndrome and primary pulmonary hypertension (PPH). ⋯ Prevention of excessive erythrocytosis, volume and blood loss substitution, cardiocirculatory pharmacologic support, prophylaxis of infective endocarditis, and judicious use of anticoagulant drugs should be applied as indicated by the type and presentation of CHD. Poor outcome of pregnancy in PPH requires an early consideration of heart-lung or lung transplantation. Multidisciplinary team effort and prolonged monitoring in the intensive care unit are mandatory to ensure a favorable outcome for cyanotic CHD and PPH parturients.
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Although the use of a gum-elastic bougie to secure an airway is well described, its use during extubation is not well documented. A bougie was passed through the endotracheal tube (ETT) prior to extubation in anticipation of possible reintubation of a patient with a difficult airway. Once the bougie was in place, the ETT was removed over it. Later, when the patient's airway did become compromised, the trachea was rapidly reintubated using the bougie, without the need for direct laryngoscopy, fiberoptic bronchoscopy, or, worse, emergency tracheostomy.