Anaesthesia
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We compared the Ambu aScope™ with a conventional fibrescope in two simulated settings. First, 22 volunteers performed paired oral and nasal fibreoptic intubations in three different manikins: the Laerdal Airway Trainer, Bill 1 and the Airsim (a total of 264 intubations). Second, 21 volunteers intubated the Airway Trainer manikin via three supraglottic airways: classic and intubating laryngeal mask airways and i-gel (a total of 66 intubations). ⋯ We conclude that the aScope performs well in simulated fibreoptic intubation and (if adapted for untimed use) would be a useful training tool for both simulated fibreoptic intubation and conduit-assisted intubation. The choice of manikin and conduit are also important in the success of such training. This manikin study does not predict performance in humans and a clinical study is required.
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Existing descriptions of ultrasound-guided fascia iliaca block focus on injection of local anaesthetic inferior to the inguinal ligament, relying on supra-inguinal spread to block the lateral femoral cutaneous nerve in the iliac fossa. In this study, we explored injectate spread and nerve involvement in a cadaveric dye-injection model, using a supra-inguinal ultrasound-guided technique that places local anaesthetic directly into the iliac fossa. Bilateral injections of 20 ml 0.25% aniline blue dye were made in six unembalmed cadavers. ⋯ We have performed more than 150 blocks in patients using this approach without complications. Injection using this technique in cadavers leads to extensive fluid spread throughout the iliac fossa. In patients this approach may allow a lower volume block of the femoral nerve and lateral femoral cutaneous nerve while still injecting at a distance from the femoral nerve.
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A 38-year-old woman experienced a massive postpartum haemorrhage 30 minutes after emergency caesarean delivery. The patient became severely haemodynamically compromised with an unrecordable blood pressure. ⋯ Blood and blood products were deployed in conjunction with intra-operative cell salvage and transoesophageal Doppler cardiac output monitoring was used to assess adequacy of volume replacement. Haemorrhage control was finally achieved with the use of recombinant factor VIIa and hysterectomy.
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Ultrasound applications in peri-operative medicine have become common place in modern anaesthesia practice. Anaesthetists have performed transoesophageal echocardiography in cardiac and selected non-cardiac surgery for over two decades. We aimed to assess the indications, impact on clinical management and accuracy of focused cardiovascular ultrasound performed by anaesthetists in the peri-operative period. ⋯ Some degree of aortic stenosis was present in 47 out of 170 (26%) of patients; mitral valve disease (30 out of 170 (18%)) and pulmonary hypertension (25 out of 170 (14%)) were also common. Changes in peri-operative management occurred in 140 out of 170 (82%) patients and major findings correlated with a formal cardiology transthoracic echocardiogram in 52 out of 57 (92%) patients. Focused cardiovascular ultrasound performed by anaesthetists in the peri-operative period accurately detects major cardiac pathology and significantly alters peri-operative management.