Intracranial hypotension headache after uncomplicated caudal epidural injection.
Anaesthesia. 2012 Jan 31;
Authors: Thomas R, Thanthulage S
Abstract
A caudal epidural injection was performed on a middle-aged woman for pain in her right foot. Although the procedure was uncomplicated and a good epidurogram was obtained, the patient went on to develop an orthostatic headache with generalised weakness and syncopal episodes that were treated successfully by epidural blood patching. We describe the aetiology, presentation and treatment of spontaneous intracranial hypotension and review the similarities with our patient’s clinical presentation. We hypothesise as to how our intervention may have resulted in a dural tear.
PMID: 22288890 [PubMed - as supplied by publisher]
Comparison of malleable stylet and reusable and disposable bougies by?paramedics in a simulated difficult intubation.
Anaesthesia. 2012 Jan 31;
Authors: Gregory P, Woollard M, Lighton D, Munro G, Jenkinson E, Newcombe RG, O’Meara P, Hamilton L
Abstract
In a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3/4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34/60 (57%) using the stylet, 18/60 (30%) using a Portex single-use bougie, 16/60 (27%) using a Frova single-use bougie and 5/60 (8%) using a Portex reusable bougie. The proportion intubating within 30 s was significantly higher with the stylet compared with any bougie (p < 0.001), but significantly lower with a Portex reusable bougie than any other device (p < 0.004). Participants rated the Portex reusable bougie as significantly more difficult to use than the other devices (p < 0.001). There was no evidence of a relationship between previous experience and success rate for any device.
PMID: 22288931 [PubMed - as supplied by publisher]
Percutaneous mitral valve repair in a ventilator-dependant patient.
Anaesthesia. 2012 Jan 23;
Authors: Davis C
Abstract
I report the case of a 57-year-old patient admitted to the intensive care unit with severe community-acquired pneumonia, complicated by prolonged mechanical ventilation of the lungs and intractable cardiac failure. He underwent percutaneous coronary angioplasty of the right coronary artery, but this did not improve his clinical condition. He was subsequently found to be suffering from mitral valve prolapse, that was felt to be the cause of recurrent episodes of severe pulmonary oedema. As open surgery was felt to be not feasible, the patient underwent percutaneous repair of his mitral valve using the MitraClip® device, and, after months of ventilatory support, was then weaned from the ventilator in a matter of days. While the procedure itself and the technology employed are still under evaluation, I conclude that the technique of percutaneous mitral valve repair may be considered for similar patients for whom open repair is contraindicated.
PMID: 22268760 [PubMed - as supplied by publisher]
Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia*
Anaesthesia. 2012 Jan 23;
Authors: Bonner JC, McClymont W
Abstract
Remifentanil patient-controlled analgesia is well established in many centres and provides satisfactory pain relief for many women in labour. We describe a patient using remifentanil patient-controlled analgesia who suffered a respiratory arrest requiring a brief period of ventilation. In our institution, remifentanil patient-controlled analgesia has been offered to women in labour since 2009. Up to this point, we had not observed any critical incidents in over 130 patients using this mode of analgesia in our labour suite.
PMID: 22268797 [PubMed - as supplied by publisher]
A comparison of Rapydan(®) patch and Ametop(®) gel for venous cannulation*
Anaesthesia. 2012 Jan 23;
Authors: Ravishankar N, Elliot SC, Beardow Z, Mallick A
Abstract
Ametop(®) gel (4% tetracaine) is used to provide topical anaesthesia for venous cannulation. Rapydan(®) patch (7% lidocaine and 7% tetracaine) has been developed to provide topical anaesthesia by a different mechanism, that of heat assisted delivery. We compared the topical anaesthetic effect of these agents for venous cannulation. One hundred healthy adults undergoing day-case surgery were randomly assigned to receive either Rapydan (n = 50) or Ametop (n = 50) before venous cannulation. Pain on insertion was scored on a visual analogue scale between 0 and 100 (where 100 = unbearable pain). Median(IQR[range]) pain scores were not different between groups with 11 (5-20 [0-72]) for Rapydan and 10 (5-24 [0-95]) for Ametop (p = 0.63). Adequate topical anaesthesia was achieved in over 90% of patients in both groups. Rapydan produces topical anaesthesia comparable with Ametop for venous cannulation.
PMID: 22268817 [PubMed - as supplied by publisher]
The influence of surgery on the onset of symptomatic coronary artery disease.
Anaesthesia. 2012 Feb;67(2):110-4
Authors: McFarlane HJ, Girdwood L, Bhaskar A, Clark D, Webster NR
Abstract
We speculated that asymptomatic patients undergoing routine surgery might be at higher risk of subsequent cardiac events. We studied 183 534 patients with no prior admission for heart disease, aged 50-75 years, admitted electively for one of five operations considered medium to low risk of peri-operative cardiac morbidity, between January 1997 and December 2005. Controls were generated from linked records. Within 3 years 3444 (1.9%) patients undergoing operations had subsequent myocardial infarction/acute coronary syndrome (MI/ACS) compared with 3708 (2.0%) controls (p < 0.001). Overall 8406 (4.6%) patients undergoing surgery had MI/ACS compared with 9306 (5.1%) controls (p < 0.001). Of patients undergoing surgery, 20.2% died compared with 25.7% of controls (p < 0.001). Patients undergoing certain surgical procedures did not have a higher incidence of readmission for cardiac events, but had a general survival benefit compared with other elective hospital admissions. Assessment for surgery may represent a health benefit beyond the original surgery.
Easy and difficult nasal intubation – a randomised comparison of Macintosh vs Airtraq(®) laryngoscopes*.
Anaesthesia. 2012 Feb;67(2):132-8
Authors: St Mont G, Biesler I, Pförtner R, Mohr C, Groeben H
Abstract
A new Airtraq(®) laryngoscope has been developed for nasal intubation. We prospectively compared tracheal intubation efficiency of the Airtraq for nasotracheal intubation vs that of the Macintosh laryngoscope in 200 patients. Depending on pre-operative airway evaluation, the patients were allocated to expected easy (n = 100) or difficult (n = 100) intubation groups, on the basis of mouth opening ≤ 2.5 cm, modified Mallampati score of 4, history of difficult intubation, obvious tumour or swelling. Patients were randomly allocated to the Macintosh or nasotracheal Airtraq technique. All easy intubations were successfully performed with the respective technique. In the expected difficult intubation group, the success rate was higher (47/50 vs 33/50; p < 0.01), the glottis view was better (Cormack and Lehane 1/2/3/4 grades: 29/17/1/3 vs 5/11/18/16, p < 0.01), mean (SD) intubation time was shorter (45(46) s vs 77(47)s, p < 0.01) and the number of optimising manoeuvres was reduced with the nasotracheal Airtraq compared with the Macintosh, respectively. For difficult nasal intubations, the nasotracheal Airtraq is more effective than the Macintosh laryngoscope.
PMID: 22251105 [PubMed - in process]
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