Anaesthesia
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Comparative Study
A comparison of the Glidescope and Karl Storz DCI videolaryngoscopes in a paediatric manikin.
A new paediatric Glidescope (Cobalt GVL Stat) has recently become available. This varies in design from the Karl Storz DCI videolaryngoscope, as it possesses a short curved disposable blade compared with the narrower straighter blade of the Storz. We compared the time taken for tracheal intubation under normal and difficult intubation conditions in a paediatric manikin. ⋯ The mean (SD) times under normal conditions were 18.8 (5.2) s vs 19.9 (6.1) s, (p = 0.16), respectively. Under difficult conditions the times were 22.6 (10.5) vs 27.0 (14.2) s, (p = 0.13), respectively. There were no differences in the visual analogue scores for field of view, ease of use, willingness to use in an emergency, and overall satisfaction.
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Comparative Study
Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgery.
It remains uncertain whether spinal anaesthesia is preferable to general anaesthesia for surgical repair of hip fracture, but one determining factor is the comparative cost. A detailed cost analysis relating to 20 consultants' intended anaesthetic practice (which provided information of consumables used) and data from the Brighton Hip Fracture Database was performed to quantify any difference in the costs of administering spinal versus general anaesthesia for patients with hip fracture. ⋯ The mean percentage cost of anaesthesia was 3.8% of hospital income per hip fracture, and personnel contributed approximately 46% of this cost. While such considerations indicate that spinal anaesthesia is financially preferable, it is unknown whether differential clinical outcomes between regional and general anaesthesia may offset this apparent monetary advantage.
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We report a case of severe sand aspiration in association with near-drowning, which led to respiratory failure secondary to the acute respiratory distress syndrome, necessitating mechanical ventilation, repeated therapeutic bronchoscopic lavage, and a stay in the intensive care unit that exceeded one month.
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Graphical displays of past and future levels of drugs may be a useful adjunct to manual dosing. We have previously found that a display of predicted future values speeds step changes in end-tidal sevoflurane. In this study anaesthetists made step changes of 0.3% in effect site sevoflurane, with and without the display and as increases and decreases. ⋯ When the predictive display was present, users made larger vaporiser dial changes of 3.9% vs 3.1% (95% CI for the difference -1.3% to -0.01%, p = 0.046) reflected in larger end-tidal changes (95% CI for the difference -0.009 vol% to -0.34 vol%, p = 0.06). There was no difference in the speed of change (220 vs 227 s (95% CI for the difference -51 to 32 s)), or in the accuracy of the change. In this study the predictive display influenced the magnitude of the step changes made by anaesthetists but did not affect the speed or overall accuracy of the change.
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Intravenous lipid emulsion is established therapy for bupivacaine induced cardiotoxicity. The benefit of combined hypertonic saline and lipid treatment is unexplored. ⋯ No difference was observed in rates of circulatory return (7/10 lipid only and 9/10 lipid plus hypertonic saline; p = 0.58) or survival (5/10 lipid only and 6/10 lipid plus hypertonic saline; p = 1.00). Some benefit to cardiac conduction may be afforded by hypertonic saline co-administered with lipid emulsion in bupivacaine-induced cardiotoxicity.