Anaesthesia
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This study analyses the relationship between the actual patient-related costs of care calculated for 145 patients admitted sequentially to an adult general intensive care unit and a number of factors obtained from a previously described consensus of opinion study. The factors identified in the study were suggested as potential descriptors for the casemix in an intensive care unit that could be used to predict the costs of care. ⋯ No associations between intensive care unit mortality, reason for admission and intensive and unit treatments and costs of care were found. Based on these results, it seems that casemix descriptors and isoresource groups for the intensive care unit that would allow costs to be predicted cannot be defined in terms of single factors.
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A case is reported in which suspicion of malignant vasovagal syndrome was aroused by a history of faints and needle phobia. The vasovagal response was successfully avoided using a gaseous induction of anaesthesia with sevoflurane. ⋯ The diagnosis of malignant vasovagal syndrome was confirmed postoperatively using a head-up tilt table test. An outline of the pathophysiology of the syndrome gives some indication for suitable anaesthetic management strategies in similar cases.
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Clinical Trial
Nasal fibreoptic tracheal intubation in anaesthetised patients breathing via a modified laryngeal mask airway.
A modified laryngeal mask airway was used to facilitate nasotracheal intubation with a fibreoptic laryngoscope. A size 4 laryngeal mask airway was modified by creating a defect at the base of the stem and removing the bars to allow passage of the fibreoptic laryngoscope from the nasopharynx to the larynx. The laryngeal mask airway cuff was split and the cut edges were sealed with silicone. ⋯ Nasal airway endoscopy and laryngoscopy were successfully achieved with the split laryngeal mask airway in place in 31 of 32 patients. Railroading the tracheal tube over the fibreoptic laryngoscope with the split laryngeal mask airway in place was successful in all 31 of these patients. This prototype split laryngeal mask airway allows good airway maintenance while fibreoptic nasotracheal intubation is performed.