Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of three types of tracheal tube for use in laryngeal mask assisted blind orotracheal intubation.
Laryngeal mask assisted blind orotracheal intubation is a technique that is best mastered under controlled circumstances. The influence of the type of tracheal tube, and positioning of the head, on the success rate of this procedure was evaluated in 90 gynaecological patients presenting for elective procedures under general anaesthesia. After induction, a laryngeal mask was introduced and its position was confirmed. ⋯ The success rates after a single attempt at blind oral intubation were 3.3%, 70.0% and 30.0% respectively (p < 0.001 and p < 0.05 when Portex was compared to Argyle and Kendall Curity types). After a maximum of three attempts, success rates were 30.0% (Argyle), 93.3% (Portex) and 76.7% (Kendall Curity). The first attempt at tracheal intubation was performed in the 'sniffing the morning air position' and this was successful in 52% of successful intubations; the second attempt using extension at the atlanto-occipital joint was successful in a further 35% of successful intubations; the third attempt used varying degrees of neck flexion and extension at the atlanto-occipital joint and this permitted successful placement of the tracheal tube in the remaining 13% of patients in whom tracheal intubation was possible.
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Case Reports
Cerebrospinal fluid cutaneous fistula. An unusual complication of epidural anaesthesia.
We describe two cases of cerebrospinal fluid-cutaneous fistula following epidural anaesthesia used for postoperative pain relief. In each case spinal headache occurred only after removal of the catheters and both patients were treated successfully with autologous blood patches.
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A new approach to the internal jugular vein is described which keeps the head and neck in the neutral position and uses bony and cartilaginous landmarks for guidelines. Venous puncture is made along an axial line drawn superiorly from the lateral edge of the bony depression caused by the insertion of the sternocleidomastoid muscle on the superior edge of the clavicle. This line, at the level of the cricoid cartilage, lies directly over the internal jugular vein. ⋯ Subsequently the internal jugular vein was cannulated successfully using the developed technique in 20 consecutive trauma patients with suspected cervical instability. An average of 1.2 (0.2) (range 1-3) attempts were made per patient to locate the vein and there were no complications. We propose this technique as a safe and reliable method of gaining central venous access in patients with possible cervical spine injury following trauma.