British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Randomized evaluation of the performance of single-use laryngoscopes in simulated easy and difficult intubation.
Single-use laryngoscopes are becoming used more widely. ⋯ Of the laryngoscopes tested, the standard reusable Macintosh laryngoscope performed best. The Europa was the best single-use laryngoscope. Some single-use laryngoscopes tested were significantly inferior to the Macintosh. This raises concern over their use in clinical practice, particularly if intubation is difficult.
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Lateral maternal tilt reduces aortocaval compression and the consequent cardiovascular instability. ⋯ Estimation of the angle of table tilt is unreliable.
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Case Reports
Postoperative extracorporeal membrane oxygenation for severe intraoperative SIRS 10 h after multiple trauma.
A 34-yr-old male suffered multiple trauma in a road traffic accident. He required right thoracotomy and laparotomy to control exanguinating haemorrhage, and received 93 u blood and blood products. Intraoperatively, he developed severe systemic inflammatory response syndrome (SIRS) with coagulopathy and respiratory failure. ⋯ The patient was stabilized within 60 min and transferred to the intensive care unit. He was weaned off ECMO after 51 h. He had no haemorrhagic complications, spent 3 weeks in the intensive care unit, and has made a good recovery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol requirement for insertion of cuffed oropharyngeal airway versus laryngeal mask airway with and without fentanyl: a dose-finding study.
The cuffed oropharyngeal airway (COPA) is a modified Guedel-type oral airway with a cuff at its distal end. The objectives of this prospective, randomized study were to compare the COPA and the laryngeal mask airway (LMA) in terms of propofol requirement with and without fentanyl pretreatment for smooth insertions. ⋯ Insertion of the COPA can be accomplished with a smaller bolus dose of propofol compared with the LMA, but propofol requirements are similar with both devices after a small dose of fentanyl.
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There is increasing emphasis on performance-based assessment of clinical competence. The High Fidelity Patient Simulator (HPS) may be useful for assessment of clinical practice in anaesthesia, but needs formal evaluation of validity, reliability, feasibility and effect on learning. We set out to assess the reliability of a global rating scale for scoring simulator performance in crisis management. ⋯ Using a global scale to assess simulator performance, we found good inter-rater reliability for scoring performance in a crisis. We estimate that two judges should provide a reliable assessment. High fidelity simulation should be studied further for assessing clinical performance.