Anaesthesia
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Failed tracheal intubation due to a difficult airway is an important cause of anaesthetic morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for tracheal intubation after failed direct laryngoscopy. ⋯ Median (IQR [range]) time to intubation using the Bonfils intubation fibrescope was 47.5 (30-80 [20-200]) s. Tracheal intubation using the Bonfils intubation fibrescope appears to be a simple and effective technique for the management of a difficult intubation.
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Of the forms of muscular dystrophy, myotonic dystrophy has the greatest systemic involvement. Although most patients with myotonic dystrophy show normal sensitivity to non-depolarising neuromuscular blocking drugs, some have been reported to show greatly increased sensitivity to these drugs, and little is known about the sensitivity of different muscles. ⋯ The calculated ED50 for the orbicularis oculi (7.77 microg x kg(-1) (95% CI 3.10-16.8 microg x kg(-1))) was lower than for the adductor pollicis (25.3 microg x kg(-1) (95% CI 20.7-43.3 microg x kg(-1))) and flexor hallucis brevis muscles (29.5 microg x kg(-1) (95% CI 11.0-85.6 microg x kg(-1); p < 0.01)). The ED90 was also lower for the orbicularis oculi (35.7 microg x kg(-1) (95% CI 14.8-66.5 microg x kg(-1))) than for the other muscles (51.8 microg x kg(-1) (95% CI 29.3-145.0 microg x kg(-1)) and 50.6 microg x kg(-1) (95% CI 5.29-642.0 microg x kg(-1)), respectively) (p < 0.01)).
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Randomized Controlled Trial Comparative Study Clinical Trial
Transoesophageal echocardiography is unreliable for cardiac output assessment after cardiac surgery compared with thermodilution.
This randomised, single-blind, double-control study compared and established prospectively the best transoesophageal echocardiography methods for determining cardiac output in patients after cardiac surgery. Thirty patients undergoing coronary artery bypass grafting were included. Measurements were taken postoperatively, after stabilisation in the intensive care unit. ⋯ The best results were transaortic measurements using the triangular shape assumption of valve opening, but some values deviated considerably, and none of these approaches reached the limit of agreement set at 30% when compared to thermodilution. Eyeball guessing was comparable to the best transoesophageal echocardiography measurements. We conclude that transoesophageal echocardiography is an unreliable tool for determination of cardiac output in intensive care after cardiac surgery.
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Randomized Controlled Trial Clinical Trial
Ease of insertion of the laryngeal tube during manual-in-line neck stabilisation.
The laryngeal tube has a potential role in airway management during anaesthesia or cardiopulmonary resuscitation. In patients with unstable necks, the head and neck may need to be stabilised manually (manual in-line stabilisation), but it is not known whether this procedure affects the ease of insertion of the laryngeal tube. We studied, in a cross-over study, 21 adult patients to compare the success rate of ventilation through the laryngeal tube between the Magill position (a pillow under the occiput and the head extended) or the manual in-line position of the head and neck (without a pillow under the occiput). ⋯ Ventilation was adequate in all 21 patients in the Magill position, but only in two of 21 patients during manual in-line positioning (p < 0.01; 95%CI for difference: 68-94%). In the Magill position, insertion of the laryngeal tube was easy in 16 patients and moderately difficult in the remaining five patients; in the manual in-line stabilisation position, insertion was moderately difficult in two patients and impossible in the remaining 19 patients. Stabilisation of the patient's head and neck by the manual in-line method made insertion of the laryngeal tube either difficult or impossible.
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Letter Randomized Controlled Trial Clinical Trial
Sub-Tenon's block without hyaluronidase.