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Новости Анестезиологии И Интенсивной Терапии


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#41 alpeli

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Отправлено 07 февраля 2009 - 11:24

Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation
V. Uppal1,*, G. Fletcher2 and J. Kinsella1
1 Section of Anaesthesia, Pain and Critical Care, Faculty of Medicine, University of Glasgow, Glasgow, UK
2 Department of Anaesthesia, Royal Alexandra Hospital, Paisley, UK

* Corresponding author: Section of Anaesthesia, Pain and Critical Care, Faculty of Medicine, University of Glasgow, Level 2, QEB Glasgow Royal Infirmary, Glasgow G31 2ER, UK. E-mail: drvishal76@rediffmail.com

Background: 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.

Methods: Twenty-five patients, ASA I–II, were recruited to the study. Patients received a standard anaesthetic technique followed by an initial placement of the i-gel. The lungs were then ventilated at three different pressures (15, 20, 25 cm H2O) using PCV. The difference between the inspired and expired tidal volumes was used to calculate the leak volume. The leak fraction was defined as the leak volume divided by the inspired tidal volume. Following these observations, the i-gel was removed and replaced with the conventional tracheal tube and the recordings repeated.

Results: There was no significant difference between the leak fractions of the i-gel and the tracheal tube at 15 and 20 cm H2O PCV. At 25 cm H2O, the median difference in leak fraction was 0.02 (P=0.014) and the median difference in leak volume was 26.5 ml (P=0.006). There was no evidence of gastric insufflations with any of the pressures used during PCV.

Conclusions: We suggest that the i-gel can be used as a reasonable alternative to tracheal tube during PCV with moderate airway pressures.

British Journal of Anaesthesia 2009 102(2):264-268; doi:10.1093/bja/aen366
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Отправлено 07 февраля 2009 - 14:30

Фвральский номер Anaesthesia открывается редакторской статьёй:
Lipid emulsion to treat drug overdose: past, present and future
J. Picard and W. Harrop-Griffiths
Imperial College Healthcare
NHS Trust, London
E-mail: johnjpicard@googlemail.com

Интересующимся вышлю текст по почте (PDF).
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Отправлено 07 февраля 2009 - 14:40

Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol
M. K. Kim 1 , J. W. Lee 2 , D. J. Jang 3 , O. Y. Shin 4 and S. B. Nam 2
1 Clinical Assistant Professor , 4 Professor, Department of Anaesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
2 Assistant Professor , 3 Fellow, Department of Anaesthesiology and Pain Medicine, and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
Correspondence to Dr Sang Beom Nam
E-mail: sbnam@yuhs.ac
Copyright © 2009 The Association of Anaesthetists of Great Britain and Ireland

ABSTRACT
The purpose of this study was to determine the effect-site concentration of remifentanil that would provide optimal conditions for successful laryngeal mask airway insertion during a target-controlled infusion (TCI) of propofol at 3.5 μg.ml−1 without the use of neuromuscular blockade. Five minutes after propofol infusion, remifentanil was infused at a dose determined by a modified Dixon's up-and-down method. Five minutes after remifentanil infusion, the laryngeal mask was inserted. The effect-site concentration of remifentanil for successful laryngeal mask insertion in 50% of adults (EC50) was 3.04 (SD 0.49) ng.ml−1 during a TCI of 3.5 μg.ml−1 propofol without neuromuscular blockade. From the probit analysis, the EC50 and EC95 of remifentanil were 2.84 ng.ml−1 (95% CI 2.09–3.57 ng.ml−1) and 3.79 ng.ml−1 (95% CI 3.26–9.25 ng.ml−1), respectively.

Anaesthesia. Volume 64 Issue 2, Pages 136 - 140
DOI: 10.1111/j.1365-2044.2008.05707.x

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Отправлено 07 февраля 2009 - 14:46

Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine
M. Mohta 1 , N. Kumari 2 , A. Tyagi 1 , A. K. Sethi 3 , D. Agarwal 4 and M. Singh 4
1 Reader , 2 Postgraduate student , 3 Professor and Head , 4 Specialist, Department of Anaesthesiology and Critical care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
Correspondence to Dr Medha Mohta
E-mail: medhamohta@gmail.com

ABSTRACT
The present study was conducted with the aims of comparing intravenous tramadol 1, 2 and 3 mg.kg−1 with pethidine 0.5 mg.kg−1 for prophylaxis of postanaesthetic shivering and to find a dose of tramadol that could provide the dual advantage of antishivering and analgesic effect in the postoperative period. The study included 165 patients, randomly allocated to five groups of 33 each. Tramadol in doses of 1, 2 and 3 mg.kg−1, pethidine 0.5 mg.kg−1 or normal saline were administered at the time of wound closure. All three doses of tramadol were effective and comparable to pethidine in preventing postanaesthetic shivering. Tramadol 2 mg.kg−1 had the best combination of antishivering and analgesic efficacy without excessive sedation and thus appeared to be a good choice to be administered at the time of wound closure to provide antishivering effect and analgesia without significant side effects in the postoperative period.

Anaesthesia. Volume 64 Issue 2, Pages 141 - 146
DOI: 10.1111/j.1365-2044.2008.05711.x

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Отправлено 19 февраля 2009 - 21:39

Hypotension in obstetric spinal anaesthesia: a lesson from pre-eclampsia
G. Sharwood-Smith and G. B. Drummond

Department of Anaesthesia, Critical Care, and Pain Medicine
Royal Infirmary
Edinburgh EH16 4HA
UK

E-mail: g.b.drummond@ed.ac.uk

Full text через личку

British Journal of Anaesthesia 2009 102(3):291-294; doi:10.1093/bja/aep003
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#46 alpeli

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Отправлено 19 февраля 2009 - 21:51

Smoking and alcohol intervention before surgery: evidence for best practice

H. Tønnesen1,*, P. R. Nielsen3, J. B. Lauritzen2 and A. M. Møller4
1 WHO Collaborating Centre for Evidence Based Health Promotion in Hospitals and Health Services
2 Orthopedic Department, Bispebjerg University Hospital, DK-2400 Copenhagen, Denmark
3 Pain Clinic, The Neuroscience Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
4 Department of Anaesthesiology, Herlev University Hospital, Herlev Ringvej, DK-2730 Herlev, Denmark

* Corresponding author. E-mail: hanne.tonnesen@bbh.regionh.dk

Smoking and hazardous drinking are common and important risk factors for an increased rate of complications after surgery. The underlying pathophysiological mechanisms include organic dysfunctions that can recover with abstinence. Abstinence starting 3–8 weeks before surgery will significantly reduce the incidence of several serious postoperative complications, such as wound and cardiopulmonary complications and infections. However, this intervention must be intensive to obtain sufficient effect on surgical complications. All patients presenting for surgery should be questioned regarding smoking and hazardous drinking, and interventions appropriate for the surgical setting applied.

British Journal of Anaesthesia 2009 102(3):297-306; doi:10.1093/bja/aen401
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Отправлено 19 февраля 2009 - 21:57

Prothrombin complex concentrate vs fresh frozen plasma for reversal of dilutional coagulopathy in a porcine trauma model
G. Dickneite,* and I. Pragst
Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany

* Corresponding author. E-mail: gerhard.dickneite@cslbehring.com

Full text

British Journal of Anaesthesia 2009 102(3):345-354; doi:10.1093/bja/aen391
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#48 alpeli

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Отправлено 19 февраля 2009 - 22:04

Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: a randomized, dose-ranging, placebo-controlled study
Y. Ginosar1,*, M. Nadjari2, A. Hoffman3, N. Firman1, E. M. Davidson1, C. F. Weiniger1, L. Rosen4, C. Weissman1, U. Elchalal2 and the ACET study group
1 Department of Anesthesiology and Critical Care Medicine
2 Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel
3 School of Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel
4 School of Public Health, Tel Aviv University, Tel Aviv, Israel

* Corresponding author. E-mail: yginosar@netvision.net.il

Background: No therapy is currently available to improve the reduced uteroplacental blood flow (UPBF) that characterizes pre-eclampsia. We hypothesized that sympathectomy induced by epidural local anaesthesia reduces uterine vascular resistance (which is inversely correlated with UPBF) in pre-eclampsia.

Methods: Ten pregnant women between 24 and 32 weeks of gestation with pre-eclampsia and uterine artery flow abnormalities were randomized to antepartum continuous epidural therapy (ACET) or control. ACET was initiated by a 5 day dose-ranging trial (ACET-1) of 0.04, 0.06, 0.08, and 0.1% ropivacaine and saline placebo, each at 10 ml h–1 for 24 h. Doses were randomized and double-blind. Doppler ultrasound indices of vascular resistance were assessed at baseline and after each 24 h dosing period in both uterine arteries. Subsequently, these ACET patients were administered 0.1% ropivacaine until delivery (ACET-2), with one additional randomized double-blind placebo day.

Results: Five patients were randomized to ACET. In each patient, one uterine artery exhibited a dose-dependent reduction in vascular resistance (P=0.035), a response that returned to baseline following placebo (P<0.001). The contralateral uterine artery exhibited either increased vascular resistance or no change. In all cases, the uterine artery that responded to ACET had higher baseline resistance than its pair (P=0.043). Baseline right–left difference in resistance between paired uterine arteries was greatly diminished following ACET. Although ACET patients had a mean (SD) duration to delivery of 19 (9) days compared with control 2 (1) days (P=0.008), this should be interpreted with caution because of demographic differences between groups.

Conclusions: ACET reduces uterine artery resistance in pre-eclampsia <32 weeks. Uteroplacental re-distribution is a novel observation and warrants further investigation.

British Journal of Anaesthesia 2009 102(3):369-378; doi:10.1093/bja/aen402
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Отправлено 19 февраля 2009 - 22:12

Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials
M. S. Abrahams*, M. F. Aziz, R. F. Fu and J.-L. Horn
Department of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA

* Corresponding author. E-mail: abrahama@ohsu.edu

Background: Despite the growing interest in the use of ultrasound (US) imaging to guide performance of regional anaesthetic procedures such as peripheral nerve blocks, controversy still exists as to whether US is superior to previously developed nerve localization techniques such as the use of a peripheral nerve stimulator (PNS). We sought to clarify this issue by performing a systematic review and meta-analysis of all randomized controlled trials that have compared these two methods of nerve localization.

Methods: We searched Ovid MEDLINE®, the Cochrane Central Register of Controlled Trials®, and Google Scholar databases and also the reference lists of relevant publications for eligible studies. A total of 13 studies met our criteria and were included for analysis. Studies were rated for methodological quality by two reviewers. Data from these studies were abstracted and synthesized using a meta-analysis.

Results: Blocks performed using US guidance were more likely to be successful [risk ratio (RR) for block failure 0.41, 95% confidence interval (CI) 0.26–0.66, P<0.001], took less time to perform (mean 1 min less to perform with US, 95% CI 0.4–1.7 min, P=0.003), had faster onset (29% shorter onset time, 95% CI 45–12%, P=0.001), and had longer duration (mean difference 25% longer, 95% CI 12–38%, P<0.001) than those performed with PNS guidance. US guidance also decreased the risk of vascular puncture during block performance (RR 0.16, 95% CI 0.05–0.47, P=0.001).

Conclusions: US improves efficacy of peripheral nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease the number of complications such as nerve injury or systemic local anaesthetic toxicity.

British Journal of Anaesthesia 2009 102(3):408-417; doi:10.1093/bja/aen384
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Отправлено 19 февраля 2009 - 22:17

Респект! Изображение

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Отправлено 19 февраля 2009 - 22:26

The efficacy of a smoking cessation programme in patients undergoing elective surgery – a randomised clinical trial
O. Sadr Azodi 1 , D. Lindström 2 , J. Adami 1 , H. Tønnesen 3 , H. Nåsell 4 , H. Gilljam 5 and A. Wladis 2
1 Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, SE-171 76 Stockholm, Sweden
2 Section of Surgery, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-11883 Stockholm, Sweden
3 Clinical Unit of Health Promotion/WHO Collaborating Centre for Evidence Based Health Promotion in Hospitals, Bispebjerg Hospital, DK 2400 Copenhagen, Denmark
4 Section of Orthopaedics, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-11883 Stockholm, Sweden
5 Department of Public Health Sciences, Karolinska Institute and Stockholm Centre of Public Health, SE-11891 Stockholm, Sweden
Correspondence to Omid Sadr Azodi
E-mail: sayed-omid.sadrazodi@ki.se

ABSTRACT
It is known that smokers constitute an important risk group of patients undergoing surgery. It is unknown how smoking cessation intervention initiated 4 weeks prior to elective surgery affects the probability of permanent cessation. We randomly assigned 117 patients, scheduled to undergo elective orthopaedic and general surgery, to smoking cessation intervention and control group. The intervention group underwent a programme initiated, on average, 4 weeks prior to surgery with weekly meetings or telephone counselling and were provided with free nicotine replacement therapy (NRT). The control group received standard care. As a result, 20/55 (36%) patients the intervention group vs 1/62 (2%) in the control group became completely abstinent throughout the peri-operative period (p < 0.001). After 1 year, those in the intervention group was most likely to be abstinent (18/55 (33%) vs 9/62 (15%) of the controls (p = 0.03). Level of nicotine dependence and obesity seemed to be a predictor of long-term abstinence (p = 0.02).

Anaesthesia Volume 64 Issue 3, Pages 259 - 265
DOI 10.1111/j.1365-2044.2008.05758.x

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Отправлено 19 февраля 2009 - 22:32

Ambulation in labour and delivery mode: a randomised controlled trial of high-dose vs mobile epidural analgesia*
M. J. A. Wilson 1 , C. MacArthur 2 , G. M. Cooper 3 and A. Shennan 4 on behalf of the COMET Study Group UK
1 Consultant Anaesthetist, Royal Hallamshire Hospital, Sheffield, UK
2 Professor of Maternal and Child Epidemiology , 3 Senior Lecturer in Anaesthesia, University of Birmingham, Birmingham, UK
4 Professor of Obstetrics, Kings and St Thomas' School of Medicine, London, UK
Correspondence to: Dr Matt Wilson
E-mail: matthew.wilson@sth.nhs.uk
*Presented in part at the Society for Obstetric Anesthesiology and Perinatology annual scientific meeting, Phoenix (Az), May, 2003.

ABSTRACT
Compared to high-dose epidurals where mobility is impossible, mobile epidurals have been shown to reduce instrumental vaginal delivery rates. The mechanism for this benefit may depend on women walking or adopting upright postures during labour. We investigated maternal motor power and ambulation of 1052 primparous women randomised to high-dose epidural (Control), Combined Spinal Epidural (CSE) or Low-Dose Infusion (LDI) as a pre-specified, secondary outcome of the Comparative Obstetric Mobile Epidural Trial. Modified Bromage power scores and the level of mobility a woman actually achieved were recorded each hour after epidural placement during first and second stage, until delivery. Relative to control, significantly more women maintained normal leg power throughout labour in both mobile groups and significantly more women with CSE maintained superior leg power for longer than with LDI. Observational analysis did not demonstrate an association between the level of ambulation a woman actually achieved after epidural placement and delivery mode.

Anaesthesia Volume 64 Issue 3, Pages 266 - 272
DOI 10.1111/j.1365-2044.2008.05756.x

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Отправлено 19 февраля 2009 - 23:12

Trauma and Acute Respiratory Distress Syndrome: Weighing the Risks and Benefits of Blood Transfusions
Benson, Alexander B.; Moss, Marc

Full text

Anesthesiology:
February 2009 - Volume 110 - Issue 2 - pp 216-217
doi: 10.1097/ALN.0b013e3181948ac0

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Отправлено 04 марта 2009 - 20:04

Выполняю пожелание.

Title: Prophylactic nasogastric decompression after abdominal surgery

Author(s): Nelson Richard L,Edwards Shamecka,Tse Bonnie

Publisher: John Wiley & Sons, Ltd

Publication Date: July 2007

Publication type: Systematic Review

Source: Cochrane

Abstract:

Background
Routine use of nasogastric tubes after abdominal operations is intended to hasten the return of bowel function, prevent pulmonary complications, diminish the risk of anastomotic leakage, increase patient comfort and shorten hospital stay.

Objectives
To investigate the efficacy of routine nasogastric decompression after abdominal surgery in achieving each of the above goals.

Search strategy
Search terms were nasogastric, tubes, randomised, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (Central), and references of included studies, from 1966 through 2006.

Selection criteria
Patients having abdominal operations of any type, emergency or elective, who were randomised prior tot he completion of the operation to receive a nasogastric tube and keep it in place until intestinal function had returned, versus those receiving either no tube or early tube removal, in surgery, in recovery or within 24 hours of surgery. Excluded will be randomised studies involving laparoscopic abdominal surgery and patient groups having gastric decompression through gastrostomy.

Data collection and analysis
Data were abstracted onto a form that assessed study eligibility, as defined above, quality related to randomizations, allocation concealment, study size and dropouts, interventions, including timing and duration of intubation, outcomes that included time to flatus, pulmonary complications, wound infection, anastomotic leak, length of stay, death, nausea, vomit ting, tube reinsertion, subsequent ventral hernia.

Main results
33 studies fulfilled eligibility criteria, encompassing 5240 patients, 2628 randomised to routine tube use, and 2612 randomised to selective or No Tube use. Patients not having routine tube use had an earlier return of bowel function (p<0.00001), a decrease in pulmonary complications (p=0.01) and an insignificant trend toward increase in risk of wound infection (p=0.22) and ventral hernia (0.09). Anastomotic leak was no different between groups (p=0.70). Vomit ting seemed to favour routine tube use, but with increased patient discomfort. Length of stay was shorter when no tube was used but the heterogeneity encountered in these analyses make rigorous conclusion difficult to draw for this outcome. No adverse events specifically related to tube insertion (direct tube trauma) were reported. Other outcomes were reported with insufficient frequency to be informative.

Authors' conclusions
Routine nasogastric decompression does not accomplish any of its intended goals and so should be abandoned in favour of selective use of the nasogastric tube.

Nasogastric decompression used routinely after abdominal surgery does not speed recovery.
This systematic review of 33 trials showed that routine use of nasogastric tube decompression after abdominal operations, rather than speeding recovery, may slow recovery down and increase the risk of some postoperative complications. On the other hand routine use may decrease the risk of wound infection and subsequent ventral hernia.
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Отправлено 17 марта 2009 - 22:11

Pre-oxygenation and apnoea in pregnancy: changes during labour and with obstetric morbidity in a computational simulation
S. H. McClelland 1 , D. G. Bogod 2 and J. G. Hardman 3
1 Specialist Registrar in Anaesthetics, Derbyshire Royal Infirmary, Derby, UK
2 Consultant Anaesthetist, City Hospital, Nottingham, UK
3 Associate Professor & Reader in Anaesthesia, University of Nottingham & Honorary Consultant Anaesthetist, Queen's Medical Centre, Nottingham, UK
Correspondence to: J. G. Hardman
E-mail: j.hardman@nottingham.ac.uk

ABSTRACT
Using the Nottingham Physiology Simulator, we investigated the effects on pre-oxygenation and apnoea during rapid sequence induction of labour, obesity, sepsis, pre-eclampsia, maternal haemorrhage and multiple pregnancy in term pregnancy. Pre-oxygenation with 100% oxygen was followed by simulated rapid sequence induction when end-tidal nitrogen tension was less than 1 kPa, and apnoea. Labour, morbid obesity and sepsis accelerated pre-oxygenation and de-oxygenation during apnoea. Fastest pre-oxygenation was in labour, with 95% of the maximum change in expired oxygen tension occurring in 47 s, compared to 97 s in a standard pregnant subject. The labouring subject with a body mass index of 50 kg.m−2 demonstrated the fastest desaturation, the time taken to fall to an arterial saturation < 90% being 98 s, compared to 292 s in a standard pregnant subject. Pre-eclampsia prolonged pre-oxygenation and tolerance to apnoea. Maternal haemorrhage and multiple pregnancy had minor effects. Our results inform the risk-benefit comparison of the anaesthetic options for Caesarean section.

Anaesthesia Volume 64 Issue 4, Pages 371 - 377
DOI 10.1111/j.1365-2044.2008.05785.x

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Отправлено 17 марта 2009 - 22:17

Tracheal tube fixation: the effect on depth of insertion of midline fixation compared to the angle of the mouth*
K. Sharma 1 , M. Varshney 2 and R. Kumar 1
1 Professor , 2 Senior Resident, Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
Correspondence to: Dr Kavita Sharma
E-mail: drkavitadn@hotmail.com
*Presented as poster at ASA 2007 annual meet held at San Francisco, USA; October 2007.

ABSTRACT
Following successful placement of a tracheal tube (TT), it is frequently moved from the midline to the angle of the mouth. This study investigates the tracheal tube tip position in the two fixation positions in 200 adult patients. Following tracheal intubation, a fibreoptic bronchoscope (FOB) was introduced through a swivel connector and the distances from the swivel connector to the lips, carina, tip of TT and the crico-tracheal membrane were measured with the TT in the midline and at the right angle of the mouth. The mean (SD) TT tip to carinal distance decreased from 3.60 (1.50) cm to 2.28 (1.55) cm in female patients, and 5.04 (1.43) cm to 3.69 (1.65) cm in male patients on moving the tracheal tube to the angle of the mouth. We conclude that there is a significant movement of the tracheal tube towards the carina on moving the TT from midline to angle of mouth and the depth of insertion of the tube should be adjusted accordingly.

Anaesthesia Volume 64 Issue 4, Pages 383 - 386
DOI 10.1111/j.1365-2044.2008.05796.x

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Отправлено 17 марта 2009 - 22:24

Awake intubation using the LMA-CTrach™ in patients with difficult airways*
A. M. López 1 , R. Valero 2 , M. Pons 3 and T. Anglada 4
1 Senior Specialist , 3 Specialist and 4 Consultant, Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
2 Consultant, Associate Professor of Anesthesiology, University of Barcelona, Barcelona, Spain
Correspondence to: Ana M López
E-mail: analopez@clinic.ub.es
*This study was presented in part at the Euroanesthesia 2008 Meeting in Copenhagen 31 May–3 June 2008.

ABSTRACT
We studied 21 patients with known difficult airways who underwent awake tracheal intubation using the LMA CTrach™. Patients were given midazolam, atropine, a continuous infusion of remifentanil and topical lidocaine applied to the oropharyx. We limited the number of insertion attempts to three and the time to adjust the view to 5 min. In case of failure, we performed awake fibreoptic tracheal intubation. We found insertion of the device was successful and well tolerated in all patients. Vocal cords could be seen immediately in nine patients and following corrective manoeuvres in 10 patients. Tracheal intubation was successful in 20 patients: 19 cases under direct vision and in one blindly. In one patient with undiagnosed lingual tonsil hyperplasia, tracheal intubation was impossible using the device. No patient had an unpleasant recall of the procedure. We conclude that the LMA CTrach is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways.

Anaesthesia Volume 64 Issue 4, Pages 387 - 391
DOI 10.1111/j.1365-2044.2008.05797.x

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Отправлено 08 апреля 2009 - 08:44

Arterial pressure management and carotid endarterectomy
M. D. Stoneham1,* and J. P. Thompson2
1 Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK
2 University of Leicester and University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK

* Corresponding author. E-mail: mark.stoneham@nda.ox.ac.uk

Acute perioperative changes in arterial pressure occur frequently, particularly in patients with cardiovascular disease or those receiving vasoactive medications, or in relation to certain cardiovascular surgical procedures. Both hypo- and hypertension are common in patients undergoing carotid surgery because of unique patho-physiological and surgical factors. Poor arterial pressure control is associated with increased morbidity and mortality after carotid endarterectomy, but good control of arterial pressure is often difficult to achieve in practice. New guidelines have emphasized the benefits of performing carotid surgery urgently in patients with acute neurological symptoms. This strategy may make perioperative arterial pressure control more challenging. However, few specific data are available to guide individual drug therapy. The incidence, implications, and aetiology of haemodynamic instability associated with carotid surgery are reviewed, and some recommendations made for its management. Close monitoring and titration of therapy are probably the most important considerations rather than specific choice of agents.

British Journal of Anaesthesia 2009 102(4):442-452; doi:10.1093/bja/aep012
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Отправлено 08 апреля 2009 - 08:50

Saline flush test for bedside detection of misplaced subclavian vein catheter into ipsilateral internal jugular vein
G. P. Rath1,*, P. K. Bithal1, G. R. Toshniwal2, H. Prabhakar1 and H. H. Dash1
1 Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
2 Wayne State University/Detroit Medical Center, Detroit, MI, USA

* Corresponding author. E-mail: girijarath@yahoo.co.in

Background: The most common misplacement during subclavian vein (SCV) catheterization is into the ipsilateral internal jugular vein (IJV). Chest radiography is the gold standard for the confirmation of correct placement. However, it is time-consuming and has the disadvantage of radiation exposure. We assessed the sensitivity and specificity of our previously reported ‘flush test’ for confirming correct central line placement.

Methods: All neurosurgical patients who underwent successful SCV catheterization on the right side by an infraclavicular approach were enrolled in this study. The flush test was performed by injecting 10 ml of normal saline in the distal port of catheter, while anterior angle of ipsilateral neck was palpated by an independent observer. A thrill of fluid elicited on the palm of hand (positive test) was suggestive of misplaced catheter into ipsilateral IJV. This was confirmed with chest fluoroscopy.

Results: SCV catheterization was performed in 570 patients. The flush test was positive in 19 patients (3.3%) and negative in 551 patients (96.7%). There were 26 (4.6%) misplacements as detected by chest radiography; 19 entered the IJV (3.3%) and seven the contralateral SCV (1.2%). In all patients who had a misplaced catheter into the ipsilateral IJV, the flush test results were positive, whereas the results were negative in patients who had normally placed catheter or misplaced catheter elsewhere. It was found that the test had 100% sensitivity and specificity to detect misplacement of SCV catheter into the ipsilateral IJV.

Conclusions: Saline flush test is a simple and sensitive bedside test that successfully detects misplaced SCV catheters into ipsilateral IJV.

British Journal of Anaesthesia 2009 102(4):499-502; doi:10.1093/bja/aep021
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Отправлено 08 апреля 2009 - 08:57

Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients
A. Jungbauer, M. Schumann, V. Brunkhorst, A. Börgers and H. Groeben*
Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Clinics Essen-Mitte, Henricistr. 92, 45136 Essen, Germany

* Corresponding author. E-mail: h.groeben@kliniken-essen-mitte.de

Background: The Berci–Kaplan video laryngoscope was developed to improve the visualization of the glottis and ease tracheal intubation. Whether this technique is also effective in patients with an expected difficult intubation is unclear. We have prospectively evaluated the conditions and success rate of tracheal intubation in patients with a Mallampati score of III or IV.

Methods: Two hundred patients, undergoing general anaesthesia, were randomized to be intubated using direct laryngoscopy (n=100) or video laryngoscopy (n=100). Visualization of the vocal cords, success rate, time for intubation, and the need for additional manoeuvres (laryngeal manipulations, head positioning, and Eschmann stylet) were evaluated.

Results: Video laryngoscopy produced better results for the visualization of the glottis using Cormack and Lehane criteria (P<0.001), success rate (n=92 vs 99, P=0.017), and the time for intubation [60 (77) vs 40 (31) s, P=0.0173]. In addition, the number of optimizing manoeuvres was also significantly decreased [1.2 (1.3) vs 0.5 (0.7), P<0.001].

Conclusions: Video laryngoscopy, when compared with direct laryngoscopy for difficult intubations, provides a significantly better view of the cords, a higher success rate, faster intubations, and less need for optimizing manoeuvres. Therefore, we feel that the video laryngoscopy leads to a clinically relevant improvement of intubation conditions and can be recommended for difficult airway management.

British Journal of Anaesthesia 2009 102(4):546-550; doi:10.1093/bja/aep013
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