Anaesthesia
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Comparative Study
Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques.
In a randomised crossover trial, we compared a wire-guided cricothyrotomy technique (Minitrach) with a catheter-over-needle technique (Quicktrach). Performance time, ease of method, accuracy in placement and complication rate were compared. Ten anaesthesiology and 10 ENT residents performed cricothyrotomies with both techniques on prepared pig larynxes. ⋯ There was one complication in the catheter-over-needle group compared to five in the wire-guided group. We conclude that the wire-guided minitracheotomy kit is unsuitable for emergency cricothyrotomies performed by inexperienced practitioners. On the other hand, the catheter-over-needle technique appears to be quick, safe and reliable.
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A questionnaire was sent to all Intensive Care Society linkmen to investigate weekend working arrangements on Intensive Care Units (ICU) in the United Kingdom. In all, 87 responses revealed that the average consultant covering ICU at weekends works a 1 in 6 rota, is responsible for 10 beds, works 8-9 h a day and receives two calls at night. Of consultants, 54% cover anaesthesia as well as ICU, 55% work a 48 h or 72 h weekend and only one in five consultants currently have fixed sessional allocation for weekend working. 83% felt that they should not cover anaesthesia as well as ICU and there was no support for consultants to be resident at night. Applying the terms and conditions of the new consultant contract for England to this average consultant would result in 6.6 Programmed Activities for the weekend and 2 days of compensatory rest.
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Randomized Controlled Trial Comparative Study Clinical Trial
The Cardiff paediatric laryngoscope blade: a comparison with the Miller size 1 and Macintosh size 2 laryngoscope blades.
The Cardiff paediatric laryngoscope blade is a single blade that has been designed for use in children from birth to adolescence. This open, randomised, crossover study compared the Cardiff blade with the straight, size 1, Miller laryngoscope blade in 39 infants under 1 years of age and the curved, size 2, Macintosh blade in 39 children aged 1-16 years. The same laryngoscopic view was obtained with the Cardiff and Miller blades in 26 patients; the view was better with the Cardiff blade in seven patients and better with the Miller blade in six (median (IQR [range]) grade of laryngoscopy 1 (1-2 [1-3]) vs. 1 (1-2 [1-3]), respectively; p = 0.405). ⋯ The Cardiff and Macintosh blades produced the same view in 32 patients; the view was better with the Cardiff blade in seven patients (median (IQR [range]) grade of laryngoscopy 1 (1-1 [1-3]) vs. 1 (1-2 [1-3]), respectively; p = 0.008). There was no difference in time to gain these views: mean (SD) 8.7 (3.0) s vs. 9.3 (2.7) s, respectively (95% CI for difference -1.58 to 0.40; p = 0.237). The Cardiff paediatric laryngoscope blade compares favourably with these two established laryngoscope blades in children.