Anaesthesia
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We performed an evaluation of non-Luer spinal devices supplied by four manufacturers or suppliers: Polymedic; Pajunk; Sarstedt; and Smiths. For each supplier, 100 evaluations were performed using a 25-G 90-mm spinal needle, 3-ml syringe, 5-ml syringe and filter needle; for comparison, 100 evaluations were performed with our standard Luer equipment. The non-Luer devices were associated with more qualitative problems compared with the Luer devices, for example, poor feel of dural puncture (9-32% vs 10%, respectively), poor observation of cerebrospinal fluid in the hub (3-27% vs 0%), and connection problem of the syringe to the spinal needle (7-33% vs 0%). ⋯ Specific concerns included poor feel of tissue planes and observation of cerebrospinal fluid (Polymedic), difficulty with connection of the syringe to the spinal needle and trocar removal (Pajunk), poor feel of tissue planes and needle flexibility (Sarstedt) and difficulty with connection of the syringe to the spinal needle (Smiths). We could not demonstrate a short-term learning curve for the new devices. Decisions on purchasing and implementation of the new non-Luer equipment will have to acknowledge that clinicians may have greater technical problems and reduced satisfaction compared with the current equipment.
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We prospectively evaluated the CEL-100 videolaryngoscope(TM) for insertion of double-lumen tracheal tubes in 48 consecutive patients who had been found to have an unanticipated Cormack and Lehane grade 3 (n=43) and grade 4 (n=5) laryngeal view and in whom two attempts at tracheal intubation using the Macintosh laryngoscope had failed. When the CEL-100 was subsequently employed, the glottic view improved in 45 (94%) patients. ⋯ This occurred on the first attempt in 27 (56%) patients, 14 (29%) on the second and two (4%) on the third. We conclude that the CEL-100 videolaryngoscope is an effective device in this context, and we therefore propose that this device can be used in circumstances when double-lumen tube insertion proves difficult.
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We investigated whether genetic variations of the beta-2 adrenergic receptor (ADRB2) modulate the haemodynamic response following spinal anaesthesia for caesarean delivery. We focused on the effects of haplotypes formed by combinations of the Arg16Gly and Gln27Glu polymorphisms. Clinical data from 143 healthy parturients were collected. ⋯ Both groups presented similar baseline characteristics. Comparatively, patients homozygous for the ArgGln haplotype presented consistently higher blood pressure levels throughout the evaluation period (p=0.001 for systolic arterial pressure variation from baseline). In conclusion, our results demonstrate that haplotype variations of the the ADRB2 modulate the haemodynamic response following spinal anaesthesia for caesarean delivery.