Anaesthesia
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Randomized Controlled Trial Comparative Study
A comparison between the GlideScope Video Laryngoscope and direct laryngoscope in paediatric patients with difficult airways - a pilot study.
The GlideScope Video Laryngoscope may improve the view seen at laryngoscopy in adults who have a difficult airway. Manikin studies and case reports suggest it may also be useful in children, although prospective studies are limited in number. We hypothesised that the paediatric GlideScope will result in an improved view seen at laryngoscopy in children with a known difficult airway, compared to direct laryngoscopy. ⋯ The GlideScope yielded a significantly improved laryngoscopic view, both with (p = 0.003) and without (p = 0.004) laryngeal pressure. The mean (SD) time taken to achieve the optimal view was 20 (8)s using conventional laryngoscopy and 26 (22)s using the GlideScope (p = 0.5). The GlideScope significantly improves the laryngoscopic view obtained in children with a difficult airway.
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Randomized Controlled Trial
Modification of Tp-e and QTc intervals during caesarean section under spinal anaesthesia.
There are no guidelines for the anaesthetic management of caesarean section in women with long QT syndrome; the description of myocardial ventricular repolarisation in healthy women during caesarean delivery could be a first step. The aim of this study was to describe modification of the QT interval, corrected for heart rate, and the interval between the peak and the end of the T-wave (Tpeak-Tend interval) during caesarean section under spinal anaesthesia. We studied 40 patients scheduled for caesarean section under spinal anaesthesia. ⋯ Corrected QT and Tpeak-Tend intervals were unchanged from pre-operative values after induction of spinal anaesthesia, but increased significantly after oxytocin injection. The choice of vasopressor did not affect the Tpeak-Tend interval. The risk-benefit balance of oxytocin bolus during caesarean delivery should be discussed with women with a history of long QT syndrome.
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Randomized Controlled Trial Comparative Study
Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction.
This study investigates the effect of suxamethonium vs rocuronium on the onset of haemoglobin desaturation during apnoea, following rapid sequence induction of anaesthesia. Sixty patients were randomly allocated to one of three groups. Anaesthesia was induced with lidocaine 1.5 mg.kg(-1), fentanyl 2 microg.kg(-1) and propofol 2 mg.kg(-1), followed by either rocuronium 1 mg.kg(-1) (Group R) or suxamethonium 1.5 mg.kg(-1) (Group S). ⋯ The median (IQR [range]) time to reach S(p)O(2) of 95% was significantly shorter in Group S (358 (311-373 [245-430]) s) [corrected] than in Group R (378 (370-393 [366-420]) s; p = 0.003), and shorter in Group SO (242 (225-258 [189-270]) s) [corrected] than in both Group R (p < 0.001) and Group S (p < 0.001). When suxamethonium is administered for rapid sequence induction of anaesthesia, a faster onset of oxygen desaturation is observed during the subsequent apnoea compared with rocuronium. However, time to desaturation is prolonged whenever lidocaine and fentanyl precede suxamethonium.
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The advances in regional techniques for blocks of the lower limb have been driven primarily by the need to produce effective analgesia in the postoperative period and beyond. These techniques are commonly performed before or after central neuraxial blockade when this technique is used to provide anaesthesia and analgesia for the surgical procedure. Increasingly, modern practice demands a shorter hospital stay, improved patient expectations and early mobilisation. This article describes the current methods and reasons for performing specific blocks to the lower limb and the management of these blocks particularly in the postoperative period.
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Randomized Controlled Trial
Determination of the optimal stylet strategy for the C-MAC videolaryngoscope.
The C-MAC videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. ⋯ The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C-MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey-stick stylet configuration performed best in the scenarios tested.