Anaesthesia
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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.
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Randomized Controlled Trial Comparative Study
Tracheal intubation with restricted access: a randomised comparison of the Pentax-Airway Scope and Macintosh laryngoscope in a manikin.
Ten anaesthetists assessed the ease of tracheal intubation (time to see the glottis, to intubate the trachea and to ventilate), using the Pentax Airway Scope and Macintosh laryngoscope in a manikin, in three simulated circumstances of restricted laryngoscopy: (1) the patient lying supine on the ground; (2) the patient lying supine on the ground with the head close to a wall; (3) the patient confined to a car driver's seat. For the Pentax Airway Scope, intubation was successful (within 2 min) in all three circumstances. ⋯ In circumstances (2) and (3), the Pentax Airway Scope needed significantly shorter time to see the vocal cords (median [95% confidence interval] for difference: 4.5 [0.5-9.5] s in circumstance (2), and 12.5 [7.0-32.5] s in circumstance (3)), shorter time to intubate (median [95% confidence interval] for difference: 21.0 [5.5-38.5] s in circumstance (2), and 40.5 [17.5-64.0] s in circumstance (3)), and shorter time to ventilate the lungs (median [95% confidence interval] for difference: 18. 3 [4.5-36.0] s in circumstance (2), and 47.5 [16.0-84.5] s in circumstance (3)). These results indicate that, in situations where access to the patient's head is restricted, the Pentax Airway Scope is more effective than the Macintosh laryngoscope.
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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.