Anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of the size of a tracheal tube and the efficacy of the use of the laryngeal mask for fibrescope-aided tracheal intubation.
We randomly allocated 60 patients with normal airways into three groups to compare the ease of fibrescope-aided tracheal intubation using 8.0-mm internal diameter (group F8) and 6.0-mm (group F6) reinforced tracheal tubes and to evaluate the efficacy of the laryngeal mask as an aid for fibreoptic tracheal intubation (group L). In group F8 tracheal intubation was optimal in 2 of 20 patients and in two patients in whom intubation over the fibrescope was difficult the attempts resulted in inadvertent oesophageal intubation. ⋯ In both groups F6 and L tracheal intubation was completed within less than about 1 min. We conclude that conventional fibrescope-aided tracheal intubation with a 6.0-mm tracheal tube is easier than with an 8.0-mm tube and that the laryngeal mask facilitates fibrescope-aided tracheal intubation.
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To determine the contribution of extracranial oxygenation on regional cerebral oxygenation measured by an Invos 3100 near-infrared spectrometer, we measured oxygenation in blood drawn from both the facial vein (draining substantially blood from forehead areas) and the jugular venous bulb. There was no correlation between regional cerebral oxygenation and facial vein oxygenation (p = 0.35) but there was a significant correlation between regional cerebral oxygenation and jugular venous bulb oxygenation (p = 0.027). ⋯ Individual changes in jugular venous bulb oxygenation were poorly reflected. Data obtained by this near-infrared spectroscopy device are an unreliable guide to the adequacy of cerebral oxygenation.
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A method of identifying the epidural space is described in which the traditional loss of resistance to air technique is combined with amplification of the sound made by the epidural needle as it traverses the interspinous ligament and the ligamentum flavum and then enters the epidural space. The method retains all the advantages of the loss of resistance to air technique whilst, in addition, the auditory amplification gives a slightly earlier warning of entry into the epidural space. The apparatus necessary is readily available and the technique is easy to use. In addition to being useful in difficult epidurals, the technique would also be an excellent teaching aid.