Anaesthesia
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Multicenter Study
Theatre monitor alarm settings: a pilot survey in Scotland and Belgium.
The use of alarms on operating theatre equipment was explored in a questionnaire to anaesthetists in Belgium and Scotland. They were presented with a scenario of a fit male having an anaesthetic for an abdominal operation. ⋯ Beyond this, the respondents considered alarms to be a method of detecting problems before they occur and they readjust alarms for each patient. They would set systolic arterial pressure alarms 30 mmHg above and below the patients normal pressure, the heart rate alarms 30 bpm above and 20 bpm below the actual rate, and the peripheral oxygen saturation lower alarm limit to 90%.
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Comparative Study Clinical Trial Controlled Clinical Trial
Laryngeal mask airway intracuff pressure estimation by digital palpation of the pilot balloon: a comparison of reusable and disposable masks.
Digital palpation of the pilot balloon provides information about the intracuff pressure of the laryngeal mask airway. The purpose of this in vitro study was to evaluate this technique for the reusable and disposable laryngeal mask airway. Ten anaesthetists and 10 recovery-unit nurses estimated intracuff pressures from low/high initial pressures before/after training. ⋯ In the post-training phase, there was a significant overall improvement to 75 (66-85) cmH2O, but target pressures remained more accurate if the initial pressure was low. Subjects in the training group could estimate 95% of pressures for both devices to within +/-10 cmH2O of the target if the initial pressure was low. We conclude that anaesthetists and recovery-unit nurses are capable of accurate estimation of intracuff pressures using the digital palpation technique following a brief period of training.
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We studied the impact of introducing percutaneous tracheostomy to our intensive care unit on the incidence and timing of tracheostomy and on the implications for surgical training. The proportion of patients receiving intensive care who underwent tracheostomy doubled from a median of 8.5% to 16.8% (p < 0.01) following the introduction of the percutaneous technique with the procedure being undertaken significantly earlier during the intensive care stay. ⋯ An increased workload may also have contributed to the rise. Surgical trainees should be encouraged to learn percutaneous techniques and training opportunities in open surgical techniques should be maximised.
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Comment Letter Randomized Controlled Trial Clinical Trial
Manual ventilation via the laryngeal mask airway.
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Fatal oesophageal perforation occurred as a complication of elective general anaesthesia for cataract extraction in a 77-year-old female patient. Tracheal intubation had been achieved, albeit with difficulty, in the course of a clinical trial of the intubating laryngeal mask.