Anaesthesia
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The i-gelTM is a supraglottic airway with a gel-like thermoplastic cuff. It has been suggested that the seal around the larynx improves following insertion. Perhaps the most intuitive hypothesis proposed for this is that cuff softening occurs during warming from ambient to body temperature. ⋯ Over 10 to 60 °C, the smallest hardness value expressed as a proportion of the largest was 88.2% and 89.8% for size 2 and 3 i-gels, respectively, and for resilience these were 92.8% and 86.2%, respectively. Over room temperature to body temperature range (21-37.4 °C), hardness decreased by 3.15% and increased by 0.47% for i-gel sizes 2 and 3, respectively, whereas resilience values decreased by 1.85% and 2.68%, respectively. Cuff hardness and resilience did generally reduce with warming, but the effect was minimal over temperature ranges that may be encountered during clinical use.
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Postoperative hospital stay is longer for frail, older patients, who are more likely to experience prolonged postoperative morbidity and reduced long-term survival. We recorded in-hospital mortality, morbidity and length of stay for 164 patients aged at least 65 years after unscheduled surgery. We evaluated pre-operative frailty with the 7-point Clinical Frailty Scale: 81 patients were 'not vulnerable' (frailty score 1-3) and 83 were 'vulnerable or frail' (frailty score ≧ 4), with mean (SD) ages of 74.7 (7.5) years vs. 79.4 (8.3) years, respectively, p < 0.001. ⋯ Postoperative morbidity was less frequent in patients categorised as 'not vulnerable' on four out of the six days it was measured (days 3, 5, 8, 14, 23, 28). Median (IQR [range]) postoperative stay was 9 (6-18 [2-221]) days for patients with frailty scores 1-3, and 22 (12-33 [2-270]) days for patients with score ≧ 4, p < 0.001. Four variables independently associated with hospital discharge, hazard ratio (95%CI): E-POSSUM, 0.74 (0.60-0.92), p = 0.007; ASA 2, 0.35 (0.13-0.98), p = 0.046, ASA 3, 0.17 (0.06-0.47), p = 0.001 and ASA 4/5, 0.08 (0.02-0.28), p < 0.001; operative severity 'major +', 0.69 (0.41-1.08), p = 0.10 and the Surgical Outcome Risk Tool, 7.75 (0.81-74.40), p = 0.08.