British journal of anaesthesia
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Randomized Controlled Trial
Effects of tracheal tube orientation on the success of intubation through an intubating laryngeal mask airway: study in Mallampati class 3 or 4 patients.
We evaluated the effects of conventional tracheal tube orientation on success of intubation through an intubating laryngeal mask airway (ILMA) in Mallampati class 3 or 4 patients. ⋯ Overall, tracheal intubation was successful in 91.5% of patients through an ILMA with a conventional tracheal tube in Mallampati class 3 or 4 patients. The first-attempt success rate was higher in the reverse group compared with the normal group, but the overall success rate was similar between the reverse and the normal groups.
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Entropy is an anaesthetic EEG monitoring method, calculating two numerical parameters: State Entropy (SE, range 0-91) and Response Entropy (RE, range 0-100). Low Entropy numbers indicate unconsciousness. SE uses the frequency range 0.8-32 Hz, representing predominantly the EEG activity. RE is calculated at 0.8-47 Hz, consisting of both EEG and facial EMG. RE-SE difference (RE-SE) can indicate EMG, reflecting nociception. We studied RE-SE and EMG in patients anaesthetized without neuromuscular blockers. ⋯ Increased RE is followed by increased SE at nociceptive stimuli in patients not receiving neuromuscular blockers. Owing to their overlapping power spectra, the contribution of EMG and EEG cannot be accurately separated with frequency analysis in the range of 10-40 Hz.
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Comparative Study Controlled Clinical Trial
Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation.
The i-gel (Intersurgical Ltd) is a novel device that differs from other supraglottic airway devices in that it has a softer and a non-inflatable cuff. Our study was designed to assess whether the i-gel is suitable to provide pressure-controlled ventilation (PCV) during anaesthesia by measuring the gas leaks and comparing these values with that of the tracheal tube. ⋯ We suggest that the i-gel can be used as a reasonable alternative to tracheal tube during PCV with moderate airway pressures.
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Comparative Study
Initial administration of hydroxyethyl starch vs lactated Ringer after liver trauma in the pig.
This study tested the circulatory effectiveness of post-trauma administration of a large intravascular volume expander, hydroxyethyl starch 130/0.4 (HES), vs standard lactated Ringer's solution (RL). ⋯ After injury, the intravascular volume expanding effect of HES was larger than that for RL. However, initial administration of HES provoked uncontrolled haemorrhage, suggesting that prioritizing intravascular volume expansion did not result in stabilization of the circulation after haemorrhage.
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The incidence of general anaesthesia (GA) has been used as a marker for the quality of obstetric anaesthesia care. Recent guidelines suggest the rate of GA for Caesarean section in parturients with pre-existing epidural analgesia for labour should be <3%. The primary purpose of this study is to determine whether or not this is an achievable standard in a university teaching hospital. We also wished to determine the factors influencing the incidence of inadequate anaesthesia. ⋯ Intraoperative conversion to GA may increase both maternal and fetal risks. Strategies to reduce the incidence may include early recognition of inadequate labour analgesia and reliable assessment of adequacy of surgical anaesthesia.