Anaesthesia
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Randomized Controlled Trial Clinical Trial
Ease of insertion of the laryngeal mask airway by inexperienced personnel when using an introducer.
The Portex introducer for the laryngeal mask airway was designed as an aid to successful insertion, acting as an idealised 'artificial hard palate' to guide the tip of the laryngeal mask into the correct position. A number of authors have investigated laryngeal mask insertion by unskilled personnel in certain situations, one example being nurses during in-hospital cardiopulmonary resuscitation. We investigated whether the introducer had any effect on the incidence of first-time successful LMA placement by unskilled personnel. ⋯ In 44 patients with the LMA being inserted according to the manufacturer's instructions, there was a 68% success rate (14 failures). In 45 patients with the LMA being inserted with the aid of a Portex introducer, there was a 96% success rate (two failures). This was a highly significant improvement (p < 0.001).
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Randomized Controlled Trial Clinical Trial
Detection of accidental oesophageal intubation. Role of the anaesthetic assistant.
Three situations in which an anaesthetic assistant might be able to detect accidental oesophageal intubation during or immediately after intubation were assessed. These were: firstly, whilst applying cricoid pressure, secondly, whilst applying gentle palpation over the trachea just above the suprasternal notch and, thirdly, after intubation by means of a 'roll test'. During cricoid pressure, tracheal intubation was correctly diagnosed in all of 10 cases. ⋯ In the 'roll test', two out of 10 tracheal and five out of 10 oesophageal intubations were misdiagnosed. In conclusion, no method could be relied on entirely and may indeed give false reassurance. Nonetheless, any doubt expressed about the tracheal tube position by the assistant should be taken seriously and a careful check made.
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The effects of prescribing guidelines for analgesia were assessed by auditing prescriptions for opioids before and after the introduction of hospital prescribing guidelines. Opioid prescriptions were collected by the pharmacy department over a 2-week period in November 1994 and repeated in November 1995. ⋯ There was a statistically significant decrease in the number of prescriptions that were inadequate for both dose and frequency according to both the British National Formulary recommendations (18-3%; p < 0.001) and our Acute Pain Service guidelines (36-17%; p = 0.001). The use of accessible prescribing guidelines promotes demonstrable improvements in opioid prescribing.
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A simple automatic device to inflate the tracheal tube cuff during emergency tracheal intubation is described. It was tested in 60 patients undergoing elective surgery and found to be a useful and efficient adjunct.