Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Intra-ocular pressure changes in patients with glaucoma. Comparison between the laryngeal mask airway and tracheal tube.
We performed a randomised prospective study in 20 patients with glaucoma to examine the effects of tracheal intubation and laryngeal mask insertion on intra-ocular pressure, mean arterial blood pressure and heart rate. After induction of anaesthesia with propofol, intra-ocular pressure decreased significantly below baseline values in both the laryngeal mask and tracheal tube groups. ⋯ In contrast, tracheal intubation was associated with a significant increase in intra-ocular pressure to above baseline values in three out of eight patients. Insertion of the laryngeal mask had minimal effects on mean arterial blood pressure and heart rate, whereas tracheal intubation significantly increased both factors relative to pre-intubation values.
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A cuffed nasopharyngeal airway was used in five cases of difficult intubation, initially to maintain anaesthesia, and subsequently to act as a landmark for the passage of a fibreoptic laryngoscope loaded with a tracheal tube. In all cases, airway patency was well preserved with the device and there were no significant problems with its use. The notion of a 'dedicated airway' for difficult intubation cases is developed. A trouble-free airway will permit time to consider solutions for difficult cases and time for the novice to learn fibreoptic laryngoscopy technique.
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Patients were questioned pre-operatively to assess the level of their knowledge with regard to anaesthetic qualifications, anaesthesia and the role of anaesthetists. Thirty-five percent did not realise that anaesthetists were qualified doctors and only 25% could mention any duties that anaesthetists might have outside the operating theatre. However, those questioned were better informed about the anaesthetist's role in monitoring the patient during surgery and recovery.