Masui. The Japanese journal of anesthesiology
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Recently, rigid indirect laryngoscopes with integrated tube guidance such as Pentax-AWS (AWS) and Airtraq (ATQ) are clinically available. They are known to improve the laryngeal view and facilitate intubation compared to the Macintosh laryngoscope (MAC). However, whether these new devices are easy to learn for novice laryngoscopists is not well understood. We surveyed medical students regarding their usefulness in intubation procedure on mannequin. ⋯ With minimal instruction including practice, the AWS seemed to achieve safer intubation with better laryngeal view for novice laryngoscopists.
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Case Reports
[Infectious endocarditis with aortic annular abscess detected by intraoperative transesophageal echocardiography].
We experienced a case of an endocarditis with persistent fever despite appropriate antibiotic therapy. Intraoperative transesophageal echocardiography showed bicuspid aortic valve with vegetations which caused a severe aortic regurgitation. ⋯ Patients with bicuspid valve infectious endocarditis incur high risk of abscess formation. It is important to have frequent observation of the infected valve preoperatively and careful observation during operation to detect further abnormalities which may cause alteration of the procedure.
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Appropriate and careful interpretation of results from clinical trials is essential for evidence-based medicine. Clinical trials for approval of new drugs and new indications are rigidly designed and conducted in highly selected patients for the safe and strict assessment of efficacy of drugs, and is associated with high internal validity but low generalizability of results. On the other hand, pragmatic trials for the assessment of effectiveness of treatment with approved drugs use less rigid design, for example, unmasked trial treatment and less strict selection of patients, and may be associated with high external but low internal validity. ⋯ However, they may be misled if component end points are of widely differing objectivity and importance to patients. Less objective end points in unmasked trials may also lead to overestimation of effects of intervention. There are many pitfalls in terms of the interpretation of the results from clinical trials, and they must be recognized for evidence-based medicine.