Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope.

BACKGROUND: Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Videolaryngoscope (MVL) in patients with predictors for difficult intubation. METHODS: The study was conducted at the Department of Anaesthesia, Copenhagen University Hospital from September to December 2013. Patients with one or more predictors of difficult intubation scheduled for general anaesthesia were assessed for eligibility. Patients were intubated using Boedeker intubation forceps and MVL. The primary endpoint was time to intubation. The secondary endpoints were intubation success rate, number of intubation attempts, intubation conditions and post-operative hoarseness. RESULTS: Thirty-three patients were assessed for eligibility, and 25 patients were included in the study with a median SARI score of 3 (IQR 3-4). Twenty-two (88%, 95% confidence interval [74-100%]) of the patients were successfully intubated by the method with a median time to intubation of 115 s (IQR 78-247). Steering and advancement of the tube were reported as acceptable in 21 (84%) and 22 cases (88%), respectively, and excellent in 10 cases (45%) for both measures. Ten cases (40%) were intubated on the first attempt. There were three cases (12%) of failed intubation; in these cases, successful intubation was obtained by using a styletted tube. CONCLUSION(S): Most patients with anticipated difficult intubation can be successfully intubated with Boedeker intubation forceps and MVL. However, endotracheal tube placement failed in 3/25 patients despite a good laryngeal view.

A prehospital use of ITClamp for haemostatic control and fixation of a chest tube.

We here present three cases in which a new device, the ITClamp Hemorrhage Control System (Innovative Trauma Care, Inc., Edmonton, Canada), was used for bleeding control and for securing a chest tube.

Survival after drowning with cardiac arrest and mild hypothermia.

The current guidelines for resucitation following hypothermia and submersion with cardiac arrest state that rewarming should be continued until a core temperature of 32-34°C is achieved, after which death can be declared if no return of spontaneous circulation has occurred. As no randomized, controlled trials exist, these treatment guidelines are mostly based on a pragmatic approach. Wheater to start or stop resuscitation is notoriusly difficult. Submersion time, water temperature, and prompt resuscitation seem to be crucial factors for outcome. We report a case of successful resuscitation after the use of mechanical chest compressions and extracorporeal circulation in a patient with cardiac arrest due to submersion and accompanying mild hypothermia with a core temperature of 32,2°C caused by submersion.

Improved survival after an out-of-hospital cardiac arrest using new guidelines.

BACKGROUND: An out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. We hypothesized that the implementations of 2005 European Resuscitation Council resuscitation guidelines were associated with improved 30-day survival after OHCA. METHODS: We prospectively recorded data on all patients with OHCA treated by the Mobile Emergency Care Unit of Copenhagen in two periods: 1 June 2004 until 31 August 2005 (before implementation) and 1 January 2006 until 31 March 2007 (after implementation), separated by a 4-month period in which the above-mentioned change took place. RESULTS: We found that 30-day survival increased after the implementation from 31/372 (8.3%) to 67/419 (16%), P=0.001. ROSC at hospital admission, as well as survival to hospital discharge, were obtained in a significantly higher proportion from 23.4% to 39.1%, P<0.0001, and from 7.9% to 16.3%, P=0.0004, respectively. Treatment after implementation was confirmed as a significant predictor of better 30-day survival in a logistic regression analysis. CONCLUSION: The implementation of new resuscitation guidelines was associated with improved 30-day survival after OHCA.

Prehospital identification of stroke--room for improvement.

INTRODUCTION: Rapid recognition of stroke is important because it allows early brain imaging and management such as thrombolytic therapy. We evaluated the identification of the diagnosis acute cerebrovascular incident in a physician-based prehospital emergency medical system. METHODS: From the Copenhagen Mobile Emergency Care Unit (MECU) register we identified patients classified as having an acute cerebrovascular incident through a 2-year period. We subsequently searched the hospital registration system and compared the consistency between the primary hospital discharge diagnosis and the MECU diagnosis made on referral. Our primary aim was to calculate the proportion of admitted patients with a hospital discharge diagnosis from the category 'acute cerebrovascular incident.' RESULTS: In total, 583 patients were included in our study. In 25 patients, no hospital discharge diagnosis could be found. Of the remaining 558 patients, a hospital discharge diagnosis of cerebrovascular incident was made for 168 (30.1%) patients. Other cerebral disease was found in 171 (30.7%), systemic disease in 52 (9.3%), and other diagnoses in 167 (29.9%). DISCUSSION: We found a low accuracy of the clinical diagnosis acute cerebrovascular incident in the prehospital setting with room and need for improvement in order to allow appropriate and expeditious referral for thrombolytic therapy.

Isobutyl-nitrite-induced methemoglobinemia; treatment with an exchange blood transfusion during hyperbaric oxygenation.

A young man was accidentally intoxicated with isobutyl nitrite by a threefold lethal dose. Due to nitrites' ability to change hemoglobine into methemoglobine the patient showed signs of severe hypoxia, which could not be treated by conventional means. Therefore the patient was rapidly transferred to a hyperbaric chamber. The patient was treated with pure oxygen at 283 kPa under which a blood exchange transfusion was performed. The patient fully recovered.

[Premedication in ambulatory surgery]. / Praemedicinering til ambulant kirurgi.

UNLABELLED: A substantive amendment to this systematic review was last made on 3 January 2000. Cochrane reviews are regularly checked and updated if necessary. OBJECTIVES: To assess the effect of anxiolytic remedication on time to discharge in adult patients undergoing day case surgery under general anaesthesia. SEARCH STRATEGY: Trials were identified by computerised searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, by checking the reference lists of trials and review articles, by handsearching three main anaesthesia journals and by contacting five researchers active in the field and the Product Information departments of the manufactures of five commonly used premedicants. SELECTION CRITERIA: All randomised controlled trials comparing an anxiolytic drug(s) with placebo before general anaesthesia in adult day case surgical patients. DATA COLLECTION & ANALYSIS: We collected data on anaesthetic drugs used, results of tests of psychomotor function where these were used to assess residual effect of premedication, and on times from end of anaesthesia to ability to walk unaided or readiness for discharge from hospital. Formal statistical synthesis of individual trials was not performed in view of the variety of drugs studied. MAIN RESULTS: Searching identified twenty-nine reports; fourteen studies, with data from a total of 1263 patients, were considered eligible for analysis. Only two studies specifically addressed the discharge question; both found no delay in premedicated patients. Three other studies used clinical criteria to assess fitness for discharge, though times were not given. Again, there was no difference from placebo. Four studies used both clinical measures and tests of psychomotor function as tests of recovery from anaesthesia. In none of these studies did the premedication appear to delay discharge, although performance on tests of psychomotor function was sometimes still impaired. Of the four studies which used tests of psychomotor function to assess recovery, three showed impaired recovery (after midazolam 7.5 mg, midazolam 15 mg or diazepam 15 mg) which might possibly interfere with discharge from hospital. REVIEWERS' CONCLUSIONS: We have found no evidence of a difference in time to discharge from hospital in patients who received anxiolytic premedication. However, in view of the age and variety of anaesthetic techniques used, inferences for current day-case practice should be made with caution.

High antibiotic consumption in Danish intensive care units?

Decreased antibiotic susceptibility among microorganisms isolated from intensive care unit (ICU) patients is found to be associated with high total antibiotic consumption or inappropriate use of antibiotics in the ICUs. The aims of this study were: 1) to characterize the antibiotic consumption in Danish ICUs, and in four ICUs with expectedly large differences in levels of antibiotic consumption, 2) to estimate the association between antibiotic susceptibility among isolated microorganisms and antibiotic consumption. This was done by: 1) a retrospective questionnaire study of the annual supply of antibiotics in 1995 to 30 ICUs in Denmark, and 2) a 2-month prospective study of patients and microbiological samples in four Danish ICUs in 1996. We found that the supply of antibiotics to Danish ICUs was substantial, with a median value of 124 DDD/100 patient days. No association was found between high consumption of antibiotics and decreased antibiotic susceptibility in the four ICUs.