Anaesthesia
-
Randomized Controlled Trial Comparative Study
Tracheal intubation using the Airtraq: a comparison with the lightwand.
The Airtraq laryngoscope is a new tracheal intubation device that has been developed for the management of normal and difficult airways. As with the lightwand, the Airtraq can be used without placing the patient in the 'sniffing position' for direct laryngoscopy. The purpose of this study was to compare the efficacy and usability of the Airtraq with that of the lightwand during routine airway management. ⋯ Intubation was performed by one of two anaesthetists experienced in the use of both devices. There was no difference in success rate, intubation time, and haemodynamic response between the two groups. In conclusion, the Airtraq and lightwand have similar efficacy in patients without risk factors for difficult intubation.
-
Randomized Controlled Trial Comparative Study
Tracheal intubation in daylight and in the dark: a randomised comparison of the Airway Scope, Airtraq, and Macintosh laryngoscope in a manikin.
Fifteen anaesthetists attempted to intubate the trachea of a manikin lying supine on the ground using the Airway Scope, Airtraq or Macintosh laryngoscope in three simulated conditions: (1) in room light; (2) in the dark and (3) in daylight. The main outcome measure was the time to ventilate the lungs after successful intubation; the secondary outcome was the success rate of ventilation within 30 s. In room light and in the dark, ventilation after successful tracheal intubation could always be achieved within 30 s for all three devices. ⋯ Ventilation was always successful for the Macintosh and Airtraq laryngoscopes, but for the Airway Scope, only one of 15 participants could successfully ventilate the lungs (p < 0.0001). Therefore, the Airway Scope may have a role for tracheal intubation under room light or in darkness, but may not be so useful in daylight. In contrast, the Airtraq may have a role in both darkness and daylight.
-
It is generally believed that plaque rupture and myocardial oxygen supply-demand imbalance contribute approximately equally to the burden of peri-operative myocardial infarction. This review critically analyses data of post-mortem, pre-operative coronary angiography, troponin surveillance, other pre-operative non-invasive investigations, and peri-operative haemodynamic predictors of myocardial ischaemia and/or myocardial infarction. ⋯ Research and therapeutic interventions should be focused on the prediction and therapy of flow stagnation and thrombus formation. Plaque rupture appears to be a more random event, distributed over the entire peri-operative admission.
-
Randomized Controlled Trial
Effect-site concentration of propofol for reduction of remifentanil-induced cough.
This study examined the effectiveness of different propofol infusion target concentrations on cough suppression, during a target-controlled remifentanil infusion. Four hundred patients were randomly assigned to receive propofol target effect-site concentrations of 0, 3.0, 4.5, or 6.0 microgxml(-1). When the propofol effect-site concentration reached the target, remifentanil was administered at a target effect-site concentration of 4.0 ngxml(-1). ⋯ The overall incidence of cough was significantly decreased in by propofol 6.0 microgxml(-1) compared with 0 or 3.0 microgxml(-1) propofol (p < 0.001). The incidence of severe cough was significantly lower with propofol 6.0 microgxml(-1) compared with 3.0 microgxml(-1) (p = 0.03). A propofol target effect-site concentration of 6.0 microgxml(-1) effectively suppressed remifentanil-induced cough when remifentanil was administrated at a target effect-site concentration of 4.0 ngxml(-1).
-
Comparative Study
The value of pulse pressure and stroke volume variation as predictors of fluid responsiveness during open chest surgery.
We investigated the ability of pulse pressure variation and stroke volume variation to predict fluid responsiveness during mechanical ventilation in patients undergoing open chest surgery by comparing their respective correlations with cardiac output changes induced by leg elevation. Serial leg elevation manoeuvres were performed before and after sternotomy in 15 patients scheduled for elective off-pump coronary bypass surgery. ⋯ These correlations were lost for both parameters following sternotomy. Our data show that pulse pressure variation and stroke volume variation are valid predictors of fluid responsiveness under closed chest conditions but that this property no longer holds when the chest is open.