Anaesthesia
-
Randomized Controlled Trial
The Parker Flex-Tip tube for nasotracheal intubation: the influence on nasal mucosal trauma.
We tested our hypothesis that use of the Parker Flex-Tip tracheal tube could reduce the incidence of nasal mucosal trauma during nasotracheal intubation when compared with a conventional tip tracheal tube. One hundred and two patients, who were scheduled for elective oral surgery in which nasotracheal intubation was indicated to optimise the surgical approach, were recruited into this study. ⋯ Nasal pain due to intubation, rated on a 100-mm visual analogue scale, was less intense with the Flex-Tip tracheal tube (median, (10th-90th percentile) 19 (12-28) mm compared with the conventional tip tracheal tube (30 (22-35) mm; p < 0.001). The Flex-Tip tracheal tube thus appeared to reduce the incidence of nasal mucosal trauma during nasotracheal intubation and the incidence of post-intubation nasal pain, compared with the conventional tip tracheal tube.
-
Reduced HLA-DR expression on monocytes has been suggested as a predictive marker of immunosuppression following very high risk surgery, but there are few reports in lower risk surgery. In 32 patients undergoing low to intermediate risk surgery, blood samples were analysed by flow cytometry for HLA-DR expression and numbers in both CD14(high) and CD14(low)CD16+ monocyte subsets. ⋯ This reduction of monocyte HLA-DR expression 24 h following lower risk surgery raises questions about the purported clinical utility of this biomarker as an early predictor of postoperative complications. Our results also suggest that surgery induces significant trafficking (i.e. mobilisation, margination and extravasation) of monocyte subsets, and that monocyte HLA-DR depression is the result of a down-regulatory phenomenon (decreased protein expression on each cell) rather than the differential trafficking of monocyte subsets.
-
Randomized Controlled Trial Comparative Study
Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i-gel in a manikin.
We compared the classic laryngeal mask airway and i-gel as adjuncts to fibrescope guided intubation in a manikin. Two methods of intubation were compared with each device: the tracheal tube directly over the fibrescope; and the tracheal tube over an Aintree Intubation Catheter. Thirty-two anaesthetists took part in this randomised crossover study. ⋯ The participants rated the ease of railroading of the tracheal tube and railroading the Aintree Intubation Catheter over the fibrescope to be significantly easier (p < 0.0001 and p = 0.002 respectively) when using the i-gel than when using the classic laryngeal mask airway. Furthermore, 30/32 (94%) of anaesthetists reported preference for the i-gel over the classic laryngeal mask airway for fibrescope guided tracheal intubation when managing a difficult airway. We conclude that the i-gel is likely to be a more appropriate conduit than the classic laryngeal mask airway for fibrescope guided intubation irrespective of the intubation method used.
-
Randomized Controlled Trial
The effect of pre-emptive use of minimal dose fentanyl on fentanyl-induced coughing.
We performed a randomised, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous fentanyl (25 microg) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Six hundred patients were randomly assigned to one of three groups to receive either 0.5 ml saline 0.9% 1 min before administration of fentanyl 150 microg (3 ml), or pre-emptive fentanyl 25 microg (0.5 ml) 1 min before administration of fentanyl 125 microg or 150 microg. The incidence of fentanyl-induced cough was significantly lower in both pre-emptive groups (7 (3.5%) for 125 microgfentanyl and 15 (7.5%) for 150 microg fentanyl) than in the saline group (37 (18.5%); p = 0.001). We conclude that pre-emptive use of fentanyl 25 microg, administered 1 min before bolus injection of fentanyl (125 or 150 microg), can effectively suppress fentanyl-induced cough.