British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Placement of the intubating laryngeal mask is easier than the laryngeal mask during manual in-line neck stabilization.
We have compared in 25 patients ease of placement of the conventional and intubating laryngeal masks while the patient's head and neck were stabilized by a manual in-line method, in a randomized, crossover study. After induction of anaesthesia and neuromuscular block, the masks were placed in turn. ⋯ Adequate ventilation was always obtained after placement of the intubating laryngeal mask, whereas ventilation was adequate in 22 of 25 patients after placement of the conventional laryngeal mask. Placement of the intubating laryngeal mask was significantly easier (P < 0.001; 95% confidence intervals (CI) for median difference 8-31 mm in VAS) and faster (P < 0.001; 95% CI for mean difference 3.2-6.2 s) than that of the conventional mask.
-
Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of a new piezoelectric train-of-four neuromuscular monitor, the ParaGraph, and the Relaxometer mechanomyograph.
The ParaGraph is a new device for monitoring neuromuscular function using a piezoelectric motion sensor. In 20 patients, monitoring of neuromuscular block produced by cisatracurium 0.1 mg kg-1 was compared using the ParaGraph and a Relaxometer 2 mechanomyograph. ⋯ There were no significant differences in the time to 100% depression of T1/T0, time to 25% recovery of T1/T0 or time to recovery of T1/T0 from 25% to 75%, measured by the two monitors. When the difference between the two monitors was plotted against the average of the two measurements, the limits of agreement for T1/T0 (-42.95, +53.98%) and the train-of-four ratio, T4/T1 (-0.28, +0.21) were too wide to allow the values given by the two monitors for individual patients to be used interchangeably.
-
Gastric pressure and volume were measured in 20 pregnant women during emergency Caesarean section under general anaesthesia with neuromuscular block. Mean gastric pressure was 11 (range 4-19) mm Hg and we can predict that 99% of women undergoing emergency Caesarean section with neuromuscular block are likely to have gastric pressures of less than 25 mm Hg (mean + 3 SD). ⋯ Gastric pressure decreased significantly after delivery (P < 0.001) to 8 mm Hg. Although we measured large gastric volumes (mean 112 (range 20-350) ml), there was no correlation between gastric volume and gastric pressure.
-
Case Reports
Failure to prevent an anaphylactic reaction to a second neuromuscular blocking drug during anaesthesia.
Skin testing is used widely to determine the drug responsible for an anaphylactic reaction during anaesthesia. When a neuromuscular blocking drug in incriminated as the cause of a reaction, it is usual for neuromuscular blocking drugs which do not produce positive skin tests to be considered safe for subsequent use during anaesthesia. We describe three patients in whom false negative skin tests led to a second severe anaphylactic reaction to another neuromuscular blocking drug.