British journal of anaesthesia
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Comparative Study
Laryngeal handshake technique in locating the cricothyroid membrane: a non-randomised comparative study.
Evaluation of the anterior neck anatomy is used to identify the cricothyroid membrane (CTM) before front of neck airway access. This has been traditionally performed using palpation which results in misidentification of the CTM in a high proportion of subjects. The 'laryngeal handshake' is currently advocated by the Difficult Airway Society as the method to identify the CTM. We sought to investigate the accuracy of this technique in females. ⋯ The 'laryngeal handshake' method of palpation is more accurate but takes longer than conventional palpation technique in locating the CTM and the midline. This is of particular relevance if a vertical incision is required to perform front of neck access when anatomy is indistinct.
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Discrepancy between a patient's subjective thermal symptoms and objective measured temperature value is common in complex regional pain syndrome (CRPS) in clinical settings. For that reason, the diagnostic validity of a single temperature measurement method has been criticised. Several studies showed that the perfusion index (PI), which is derived from pulse oximetry, is a more sensitive and earlier indicator of sympathetic blockade than temperature measurement. ⋯ The accuracy of detection of subjective abnormal thermal sensations was superior for PI compared with the temperature measurement method. PI was a more sensitive measure for detecting vasomotor symptoms in CRPS compared with temperature.
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Prevention of persistent pain after breast cancer surgery, via early identification of patients at high risk, is a clinical need. Psychological factors are among the most consistently proposed predictive parameters for the development of persistent pain. However, repeated use of long psychological questionnaires in this context may be exhaustive for a patient and inconvenient in everyday clinical practice. ⋯ Using a data-driven machine-learning approach, a short list of seven items from BDI and STAI is proposed as a basis for a predictive tool for the persistence of pain after breast cancer surgery.