British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study
Tracheal intubation with videolaryngoscopes in patients with cervical spine immobilization: a randomized trial of the Airway Scope and the GlideScope.
The GlideScope (Verathon Inc., Bothell, WA, USA) and Airway Scope (Hoya Corp., Tokyo, Japan) have both been used for difficult airway management, including in patients with cervical spine pathology. The Airway Scope's disposable blade has a tube channel to guide tracheal tube insertion through the glottis. Our hypothesis is that this tube guidance system improves the ease of tracheal intubation compared with the GlideScope, which does not have a tube guiding system. We tested this hypothesis in a randomized comparison of the two videolaryngoscopes in patients whose cervical spines were immobilized. ⋯ These results suggest that the Airway Scope's tube guide system enables more rapid tracheal intubation compared with the GlideScope in patients with cervical spine immobilization.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Droperidol has comparable clinical efficacy against both nausea and vomiting.
Droperidol is commonly noted to be more effective at preventing postoperative nausea (PON) than vomiting (POV) and it is assumed to have a short duration of action. This may be relevant for clinical decisions, especially for designing multiple-drug antiemetic regimens. ⋯ We conclude that droperidol prevents PON and POV equally well, yet its duration of action is short-lived.
-
Randomized Controlled Trial
Influence of patient-controlled i.v. analgesia with opioids on supraventricular arrhythmias after pulmonary resection.
Postoperative supraventricular arrhythmias (SVA) are common after pulmonary resection and autonomic imbalance is thought to be one of the triggers. Opioids can increase parasympathetic activity and may balance heightened sympathetic tone after operation. We have examined the effect of postoperative patient-controlled analgesia (PCA) with opioids on postoperative SVA. ⋯ PCA with opioids (fentanyl and tramadol) can reduce postoperative SVA after pulmonary resection compared with PCEA with ropivacaine.
-
McDonnell highlights the differences in managing the collapsed parturient, namely:
- Need to prevent aortocaval compression.
- Early securing of the airway.
- Rapid perimortem Caesarean delivery.
- Likelihood of a non-cardiac/pregnancy cause.
The two cases presented include arrest due to ruptured uterus and arrest possibly due to iatrogenic magnesium overdose. Both resulted in favorable, though not perfect, outcomes for mother and baby.
The need for delivery suite ‘perimortem cesarean section packs’ is also discussed, as well as the use of regular simulation training.
summary -
Randomized Controlled Trial
Randomized controlled trial of intubation with the McGrath Series 5 videolaryngoscope by inexperienced anaesthetists.
The McGrath Series 5 videolaryngoscope might reduce the incidence of unexpected difficult tracheal intubation. If it also performs as well as a standard laryngoscope during uncomplicated intubations, there would be an argument for the McGrath to become the laryngoscope of choice in higher risk settings, such as rapid sequence induction by inexperienced anaesthetists. Therefore, we compared the McGrath and the Macintosh laryngoscopes during routine tracheal intubation performed by inexperienced anaesthetists. ⋯ There were no advantages to using the McGrath laryngoscope for uncomplicated tracheal intubation and duration of intubation was longer, so it should not be used as a first-line laryngoscope instrument by inexperienced anaesthetists.