Anaesthesia
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Randomized Controlled Trial Clinical Trial
An evaluation of the factors influencing selection of the optimal size of laryngeal mask airway in normal adults.
The purpose of this randomised single blinded study was to determine the optimal size of laryngeal mask airway in the normal adult population, to test the validity of the current selection criteria and to determine if any externally measured anatomical variable correlated with optimal size. In each of 30 apnoeic anaesthetised adults weighting less than 100 kg, size 3, 4 and 5 laryngeal mask airways were inserted in random order by a skilled user and the cuff inflated to a standard pressure (60 cm H2O). Optimal size was based on four criteria in order of priority: number of attempts at placement, oropharyngeal leak pressure, fiberoptic score and percentage of vocal cords seen. ⋯ Potentially useful new strategies may be to use the size 5 in all adults, or a size 5 > or = 165 cm in height and size 4 for < 165 cm. We conclude that predicting the optimal size of laryngeal mask airway for individual adult patients is complex. The best size selection strategies involve use of the size 4 and 5 laryngeal mask airways in adults.
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Obstructive sleep apnoea syndrome in children is a complex disorder characterised by repeated nocturnal episodes of increased upper airway resistive load. It is most commonly associated with adenotonsillar hypertrophy and more children are now presenting for adenotonsillectomy. ⋯ This is of importance as patients with undiagnosed obstructive sleep apnoea syndrome may experience additional peri-operative morbidity when undergoing incidental surgery. This article aims to review the aetiology, pathophysiology, clinical presentation and anaesthetic management of children with obstructive sleep apnoea syndrome.
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Clinical Trial Controlled Clinical Trial
The best view at laryngoscopy using the McCoy laryngoscope with and without cricoid pressure.
The best view obtained by levering the tip of the McCoy laryngoscope blade with or without modified cricoid pressure was studied in 100 patients presenting for general surgery. The airway was assessed pre-operatively (Mallampati score, thyromental distance, mouth opening, protrusion of the jaw and weight) in an attempt to identify the patients who might benefit from the use of the McCoy laryngoscope. The vocal cords were visible at laryngoscopy with the blade in the neutral position in 32 cases. ⋯ The epiglottis only was seen in 18 patients and in two not even the epiglottis could be visualised. Elevation of the blade or modified cricoid pressure improved the view in 38/68 cases and 57/68 cases, respectively (p < 0.001, Wilcoxon signed rank). Using our method of pre-operative assessment we were unable to identify those patients who might benefit from either manipulation.
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This article reports the results of a survey of acupuncture practice in chronic pain clinics in the United Kingdom. The survey reveals that acupuncture is widely used in the treatment of chronic pain with 84% of those responding stating that is was available at their clinics. The majority of practitioners had attended a course at one of the 'acupuncture schools' but in about one fifth of the clinics the practitioner had not received any formal training.
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We report a case of paraplegia in the immediate postoperative period following right bilobectomy for carcinoma of the lung. An epidural catheter had been inserted following induction of anaesthesia and an infusion of bupivacaine 0.15% was used for postoperative pain relief. Magnetic resonance imaging failed to reveal any spinal or epidural haematoma or spinal cord ischaemia. ⋯ Two days later he sustained a cardiac arrest and died. Post-mortem examination demonstrated spinal cord infarction and severely stenosed spinal arteries. The thoracotomy position and/or intra-operative hypotension might have compromised the blood flow to the spinal cord and although suspected as a possible cause, the use of epidural analgesia was not implicated.