Anaesthesia
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The AAI index, the BIS index and end-tidal concentration during wash in and wash out of sevoflurane.
The bispectral index (BIS), auditory evoked potential index (AAI) and the end-tidal sevoflurane concentration were studied during induction and emergence in 10 ASA I-II patients. Both during 'wash-in' and 'wash-out' of sevoflurane, the AAI and BIS indices show huge variability and an overlap of indices between awake and not responding to command. ⋯ Mean (range) BIS was 85 (73-98) and 48 (10-83) awake and unconscious, respectively, and mean AAI index was 71 (43-99) and 21 (4-85), respectively. This study demonstrates the difficulties of using processed EEG variables in real time in a clinical situation of non-steady state pharmacodynamics.
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Comparative Study
Prevalence of a training module for difficult airway management: a comparison between Japan and the United Kingdom.
To examine the education of trainees with regard to difficult airway management, we sent a questionnaire to all 89 Japanese University Departments of Anaesthesia (to be answered by a person who was responsible for teaching trainees) and all 280 Royal College of Anaesthetists' Tutors in the UK. The presence or absence of a formal training module for difficult airway management, timing and methods of training, types of airway devices that should be taught, and tutors' expertise with various techniques and devices were surveyed. Sixty-seven of the 89 Japanese tutors (75%) and 167 of 280 UK tutors (60%) replied to the questionnaire. ⋯ In six Japanese departments (9%) and 115 (69%) UK departments, equipment for percutaneous transtracheal ventilation was readily available. Airway devices and techniques that tutors considered necessary to be mastered in the first 2 years of training, differed considerably between Japan and the UK, with notable differences in the use of gum elastic bougies and awake intubation. A training module for difficult airway management is often not provided and equipment for emergency transtracheal ventilation is often unavailable in both countries.
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Major shoulder surgery can be extremely painful. Interscalene brachial plexus catheters provide excellent postoperative analgesia but are technically difficult to place. A new insulated Tuohy needle system for plexus catheterisation is now available. ⋯ Mean [range] catheter insertion time was 3.6 [1-10] min. Decreased block and catheter insertion times were associated with experience with the equipment when comparing the mean (SD) times for the first seven catheters and the last seven catheters inserted (12.1 (4.2) min vs. 7.9 (2.4) min), p < 0.05). It is concluded that the insulated Tuohy needle system for interscalene catheterisation proved easy to use in the hands of someone who had not used it before, and can be recommended.
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We evaluated the modified Airway Management Device (AMDTM) in 60 spontaneously breathing anaesthetised patients. The insertion and removal of the device was very easy and atraumatic. The airway was secured on the first attempt in 41 patients (70%; 95% CI 57-80%). ⋯ Ten of these patients were male and two were female; the failure rate was 33% (12-31%) among the male patients and 6% (2-22%) among the female patients. The cuff volumes ranged from 4 ml to 80 ml and cuff pressures from 6 cm H2O to 92 cm H2O. Blood was seen on removal in three patients (6%; 2-16%) and nine patients (18%; 10-30%) experienced sore throat after removal of the device.