ABSTRACT
BACKGROUND: Current evidence suggests that there is uncertainty about which videolaryngoscope performs best in obstetric anaesthesia. The aim of this study was to compare C-MAC and King Vision® videolaryngoscopes and direct laryngoscopy for tracheal intubation of patients undergoing caesarean section. METHODS: One hundred and eighty women were randomly assigned. The primary outcome was the time to tracheal intubation. Secondary outcomes were the time to the best laryngeal view, grade of Cormack and Lehane view, overall and first-pass success, intubation difficulty, the number of intubation attempts and optimisation manoeuvres; and complications. RESULTS: The time to successful intubation, first-pass and overall success rates did not differ between the devices. The difficulty of intubation was less for C-MAC than King Vision® (Pâ¯<0.001). No difference was observed between King Vision® and direct laryngoscopy (P=0.06) or C-MAC and direct laryngoscopy (P=0.05). King Vision® required the longest time to best laryngeal view (9⯱â¯6â¯s, P=0.028), had the highest rate of grade 1 view (47 (80%) patients, Pâ¯<0.001), and the highest need for optimisation manoeuvres (59 (100%) patients, Pâ¯<0.0001). Five minor complications were recorded with King Vision® and one with direct laryngoscopy. CONCLUSIONS: Compared to direct laryngoscopy, C-MAC and King Vision® did not prolong the time to intubation, supporting these videolaryngoscopes as primary intubation devices in obstetric anaesthesia. The C-MAC was easier to use and needed fewer additional manoeuvres than the King Vision®. The C-MAC may be better suited for tracheal intubation of obstetric patients undergoing caesarean section.
Subject(s)
Laryngoscopes , Laryngoscopy/instrumentation , Adult , Female , Humans , Intubation, Intratracheal , Laryngoscopy/adverse effects , Pregnancy , Prospective Studies , Video RecordingABSTRACT
This study compared the influence of the Trendelenburg position on haemodynamics in non-anaesthetized spontaneously breathing healthy volunteers and anaesthetized, mechanically ventilated patients with ischaemic heart disease scheduled for coronary artery bypass graft (CABG) surgery. Placing the anaesthetized patients scheduled for CABG surgery in the Trendelenburg position resulted in a significant increase in cardiac output and mean arterial pressure and a non-significant decrease in heart rate. In contrast, in the non-anaesthetized healthy volunteers, heart rate increased significantly but both cardiac output and mean arterial pressure changed non-significantly. Further studies will be needed to evaluate the haemodynamics of the Trendelenburg position.
Subject(s)
Anesthesia , Coronary Artery Bypass , Hemodynamics , Myocardial Ischemia/physiopathology , Posture , Aged , Blood Pressure , Case-Control Studies , Female , Heart Rate , Humans , Male , Middle Aged , Myocardial Ischemia/surgeryABSTRACT
BACKGROUND AND OBJECTIVE: The purpose was to study the agreement between cardiac output measurements with electrical velocimetry vs. intermittent thermodilution before and after coronary artery bypass graft surgery. METHODS: Cardiac output was measured simultaneously with electrical velocimetry and intermittent thermodilution before and immediately after coronary artery bypass graft surgery, and in the intensive care unit. Measurements were performed in three different body positions. The results were analysed according to Bland and Altman. RESULTS: The mean bias of all 150 paired measurements in 16 patients was 0.21 +/- 0.78 L min(-1), and the mean error was 40%. Before skin incision the mean bias was 0.04 +/- 0.41 L min(-1), and the mean error was 25%. After skin closure the mean bias was 0.57 +/- 0.92 L min(-1), and the mean error was 42%. In the intensive care unit the mean bias was 0.26 +/- 0.68 L min(-1), and the mean error was 32%. CONCLUSIONS: The agreement between cardiac output measurements with electrical velocimetry and intermittent thermodilution was clinically acceptable only before skin incision in coronary artery bypass graft surgery. The mean error was unacceptably high immediately after skin closure and was at a borderline level in the intensive care unit. Thus, the overall accuracy of cardiac output measurements with the electrical velocimetry technique during coronary artery bypass graft surgery is not clinically unacceptable.
