British journal of anaesthesia
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A 63-yr-old woman was anaesthetized for sub-total thyroidectomy. The thyroid gland was large, deviating the trachea to the right and causing 30% tracheal narrowing at the level of the suprasternal notch. Mask ventilation was easy but laryngoscopy was Cormack and Lehane grade 3. ⋯ An intubating laryngeal mask was inserted and although the airway was clear and ventilation easy, it was not possible to intubate the trachea either blindly or with the fibreoptic bronchoscope. Tracheal intubation was eventually achieved using a 6.5-mm cuffed oral tracheal tube via a size 4 laryngeal mask under fibreoptic control. We describe the case in detail and discuss the use of the intubating laryngeal mask, its potential limitations and how to optimize its use in similar circumstances.
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Case Reports Clinical Trial Controlled Clinical Trial
Propofol infusion for induction and maintenance of anaesthesia in patients with end-stage renal disease.
We have investigated the pharmacokinetics and pharmacodynamics of propofol in 11 patients with end-stage renal disease (ESRD) compared with nine healthy patients during and after a manually controlled three-stage infusion of propofol 21, 12 and 6 mg kg-1 h-1 lasting a minimum of 2 h. Mean total body clearance was not reduced significantly in the ESRD group (30.66 (SD 8.47) ml kg-1 min-1) compared with the control group (33.75 (7.8) ml kg-1 min-1). ESRD patients exhibited a greater, but not statistically significant, volume of distribution at steady state compared with patients in the control group (11.25 (8.86) vs 5.79 (2.14) litre kg-1, respectively). ⋯ Waking time after cessation of propofol infusion was significantly shorter in the ESRD group (474 (156) s) compared with the control group (714 (240) s) (P < 0.05). Mean plasma concentrations on waking were similar. We conclude that the pharmacokinetic and pharmacodynamic profiles of propofol after infusion were not markedly affected by renal failure.