Anaesthesia
-
The authors present three cases where catheters placed in the oblique sub-costal transversus abdominis plane provided prolonged analgesia after upper abdominal surgery. Patient 1 was admitted with severe sepsis following major hepatobiliary surgery. Bilateral catheters facilitated weaning from mechanical ventilation and provided adequate analgesia for 4 days. ⋯ The transversus abdominis plane catheters provided a significant opioid sparing effect. A unilateral catheter offered rescue analgesia in patient 3 when the epidural catheter was displaced. We put forward a case for oblique sub-costal transversus abdominis plane catheters as an alternative to epidural analgesia after upper abdominal surgery.
-
Randomized Controlled Trial Comparative Study
A comparison of the i-gel with the LMA-Unique in non-paralysed anaesthetised adult patients.
This study assessed two disposable devices; the newly developed supraglottic airway device i-gel and the LMA-Unique in routine clinical practice. Eighty patients (ASA 1-3) undergoing minor routine gynaecologic surgery were randomly allocated to have an i-gel (n = 40) or LMA-Unique (n = 40) inserted. Oxygen saturation, end-tidal carbon dioxide, tidal volume and peak airway pressure were recorded, as well as time of insertion, airway leak pressure, postoperative sore-throat, dysphonia and dysphagia for each device. ⋯ Post-operative sore-throat and dysphagia were comparable with both devices. Both devices appeared to be simple alternatives to secure the airway. Significantly higher airway leak pressure suggests that the i-gel may be advantageous in this respect.
-
Randomized Controlled Trial
Fibreoptic intubation through the laryngeal mask airway: effect of operator experience*.
In a randomised crossover study, we compared times and success rates for tracheal placement of a fibrescope and railroading of a tracheal tube through the classic laryngeal mask airway by anaesthetists with limited experience in fibreoptic intubation (trainees) and those who were experts. Thirty-two patients, 32 trainees and three experts took part. ⋯ There was no significant difference in the number of attempts needed for successful placement of the fibrescope (p = 0.12) and railroading the tracheal tube (p = 0.22). The differences between experts and trainees when using fibrescope assisted intubation via the classic laryngeal mask airway were not clinically important.
-
Multicenter Study
A documented previous difficult tracheal intubation as a prognostic test for a subsequent difficult tracheal intubation in adults.
We investigated the diagnostic accuracy of a documented previous difficult tracheal intubation as a stand-alone test for predicting a subsequent difficult intubation. Our assessment included patients from the Danish Anaesthesia Database who were scheduled for tracheal intubation by direct laryngoscopy. ⋯ Our assessment demonstrates that a documented history of previous difficult or failed intubation using direct laryngoscopy are strong predictors of a subsequent difficult or failed intubation and may identify 30% of these patients. Although previous investigators have reported predictive values that exceed our findings markedly, a documented previous difficult or failed tracheal intubation appears in everyday anaesthetic practice to be a strong predictor of a subsequent difficult tracheal intubation.
-
Letter Case Reports
Palatal perforation associated with McGrath videolaryngoscope.