Anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of the Intersurgical Solus laryngeal mask airway and the i-gel supralaryngeal device.
Summary We compared the performance of the Intersurgical Solus laryngeal mask airway (LMA) with that of the i-gel in 120 patients of ASA physical status during general anaesthesia with respect to oropharyngeal leak pressure, peak airway pressure, airway manipulation, insertion time, fibreoptic view, ventilatory parameters, and peri-operative complications. After receiving a standardised induction of anaesthesia, either a Solus LMA (60 patients) or an i-gel (60 patients) was inserted. One hundred and fifteen patients completed the study. ⋯ A better fibreoptic view of the larynx was obtained in patients in the LMA group (p = 0.02) compared to those in the i-gel group and less airway manipulation was required in the LMA group (p < 0.01). Both devices have good performance with very low peri-operative complications. However, the Solus LMA provides a better oropharyngeal seal, provides a better fibreoptic view, and requires less manipulation to secure the airway than the i-gel.
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Flexible fibreoptic intubation is widely accepted as an important modality for the management of patients with difficult airways. We compared the aScope, a novel, single-use, flexible video-endoscope designed to aid tracheal intubation, with a standard flexible intubating fibrescope, by examining the performance of 21 anaesthetists during an easy and difficult intubation simulation in a manikin. Intubation success, time for intubation, and rating of the devices (using a scale from 1, excellent to 6, fail) were documented. ⋯ The aScope was also successfully used to facilitate tracheal intubation in five patients with anticipated or unanticipated difficult airways. Picture quality was sufficient to identify the anatomical landmarks. Although the performance of the aScope is acceptable, it does not meet the current quality of standard flexible intubation fibrescopes.
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This prospective, observational volunteer study aimed to describe the appearance of the great auricular nerve using ultrasound and its blockade under ultrasound guidance. An in-plane needle guidance technique was used for blockade of the great auricular nerve with 0.1 ml mepivacaine 1%. ⋯ The great auricular nerve was successfully seen in all volunteers and the tail of the helix, antitragus, lobula and mandibular angle were blocked in all cases whereas the antihelix and concha were never blocked. Ultrasound imaging of the great auricular nerve can be reliably achieved and successful blockade with minimal volumes of local anaesthetic is another example of the benefits of ultrasound-guided peripheral nerve blocks.