Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy.
A randomised controlled trial was conducted to compare the efficacy of upper body forced-air warming (Bair Hugger, Augustine Medical model 500/OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Bromma, Sweden) for maintenance of intra-operative body temperature in 60 patients undergoing laparotomy under general anaesthesia. The nasopharyngeal temperature was recorded throughout the operative period. The mean (SD) final temperatures were 36.2 (0.4) degrees C with forced-air warming and 35.5 (1.0) degrees C with electric heating pad (p < 0.01). Upper body forced-air warming is more effective than the heating pad for maintenance of body temperature during laparotomy.
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Randomized Controlled Trial
The Airtraq as a rescue airway device following failed direct laryngoscopy: a case series.
We report the successful use of the Airtraq as a rescue device following failed direct laryngoscopy, in patients deemed at increased risk for difficult tracheal intubation. In a series of seven patients, repeated attempts at direct laryngoscopy with the Macintosh blade, and the use of manoeuvres to aid intubation, such as the gum elastic bougie placement, were unsuccessful. In contrast, with the Airtraq device, each patient's trachea was successfully intubated on the first attempt. This report underlines the utility of the Airtraq device in these patients.
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We wished to investigate whether intensive care represents good value for money to the National Health Service in the UK using cost-effectiveness analysis. We developed a cost-effectiveness model using secondary data sources to estimate the incremental cost per quality adjusted life year gained of treatment in intensive care vs non-intensive care treatment in adults. Estimates of hospital mortality with and without intensive care were obtained from seven published studies and from data published by the Intensive Care National Audit and Research Centre. ⋯ This figure is sensitive to the mortality risk reduction associated with intensive care. Despite the high daily cost of intensive care, its cost-effectiveness is excellent and compares favourably with other commonly used health interventions. Our findings suggest that adult intensive care represents good value for money.
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Randomized Controlled Trial
Fibreoptic intubation using three airway conduits in a manikin: the effect of operator experience.
In a randomised cross-over study, 72 anaesthetists (24 Senior House Officers, 24 Specialist Registrars and 24 Consultants) attempted to place a fibreoptic scope in the trachea of a manikin using three airway conduits: the Berman airway, the LMA Classic(trade mark) and the intubating laryngeal mask airway. The time for insertion of the airway conduit, delivery of two breaths and fibreoptic scope placement in the trachea was the primary endpoint. ⋯ The LMA Classic was considered to be the easiest conduit to use for fibreoptic scope placement by all grades of anaesthetists. We conclude that the LMA Classic is the most effective conduit for fibreoptic scope placement especially for anaesthetists with limited experience in its use.