Anaesthesia
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There are many simulators available for use in anaesthetic-related education and research. Those who wish to purchase a simulator or to establish a simulation facility face a daunting task in understanding the differences between simulators. ⋯ It would be difficult to deal in detail with every simulator ever made for anaesthesia, but in the present review we cover the spectrum of currently available anaesthetic simulators, provide an overview of different types of simulator, and discuss a selection of simulators of particular interest, including some of historical significance and some examples of 'home made' simulators. We have found no common terminology amongst authors for describing or classifying simulators, and propose a framework for describing (or classifying) them that is simple, clear and applicable to any simulator.
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The objective of this study was to compare linear and non-linear analysis of heart rate variability (HRV) in terms of correlation with haemodynamic fluctuation during induction of general anaesthesia. Pre-operatively, HRV was estimated by the MemCalc method in 114 patients scheduled for general anaesthesia. ⋯ As an index of non-linear analysis of HRV, ultra short-term entropy (UsEn) correlated better with blood pressure fluctuation than did the ratio of the power of low frequency component of HRV to that of high frequency component (LF/HF). In contrast, although LF/HF significantly correlated with heart rate increase caused by tracheal intubation, the correlation between UsEn and heart rate fluctuation was not significant.
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An 82-year-old ASA 2 patient underwent routine sub-Tenon's block for cataract surgery. One minute after injection of the local anaesthetic, the patient had a generalised tonic-clonic seizure and developed refractory ventricular fibrillation; subsequent resuscitation was unsuccessful. With no evidence for intravascular injection, the lack of structural brain abnormalities, and the most striking feature on post mortem examination being severe triple vessel coronary artery disease, it was concluded that this was primarily cardiac in origin; however, the possibility of brainstem anaesthesia should also be considered.
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The risk of endobronchial intubation during laparoscopy because of displacement of the tip of the tracheal tube is a well known problem in adults. Laparoscopy in children is increasingly performed, but there are no data available regarding the above problem. ⋯ Maximal displacement of the tip of the tracheal tube tip in cm was 0.5+(0.05xage (years)) for 20 degrees head-down tilt, 0.6+(0.09xage (years)) for capnoperitoneum alone, and 1.2+(0.11xage (years)) for 20 degrees head-down tilt with capnoperitoneum. In no patients did endobronchial intubation occur with the tracheal tube placed according to the intubation depth marking.
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Case Reports
Non-conventional uses of the Aintree Intubating Catheter in management of the difficult airway.
We present 14 cases, of which three have been previously reported, in which non-conventional use was made of the Aintree Intubating Catheter (AIC). In seven cases the AIC was used via a ProSeal Laryngeal mask airway (PLMA). Two patients had anticipated difficult intubation, two unexpected difficult intubation and two required rescue of an obstructed airway prior to AIC-assisted intubation. ⋯ In eight cases the anaesthetist had no experience of the technique outside workshops. These cases demonstrate general utility of the technique and successful use of the AIC via the PLMA, in awake patients, as an adjunct to fibre-optic intubation and in patients with an oedematous larynx. Finally, cases where the combination of the PLMA and AIC was unsuccessful demonstrate the technique, like many, is not always successful.