Randomized evaluation of the performance of single-use laryngoscopes in simulated easy and difficult intubation.

BACKGROUND: Single-use laryngoscopes are becoming used more widely. METHODS: We compared six types of single-use laryngoscope with the standard Macintosh laryngoscope using the Laerdal SimMan patient simulator. Twenty anaesthetists attempted to intubate the simulator with standardized airway settings allowing a full view of the vocal cords ('easy intubation'). The airway settings were then changed so that only the posterior part of the glottis was visible ('difficult intubation') and the anaesthetists were asked to intubate the simulator again. RESULTS: The time to intubate with the standard laryngoscope was less in both easy (P<0.05) and difficult (P<0.01) intubations. The performance of five laryngoscopes during easy intubation (P<0.01) and four during difficult intubation (P<0.001) was significantly worse than that of the Macintosh. There was a significant difference in Cormack and Lehane grading between the laryngoscopes tested in both easy (P<0.05) and difficult (P<0.05) intubation. The percentage of glottic opening visible (POGO score) also differed between laryngoscopes in both the easy (P<0.01) and difficult (P<0.001) groups. The highest POGO scores were obtained with the Macintosh laryngoscope. During the difficult intubation simulation, the reusable Macintosh laryngoscope needed less use of a bougie and had fewer failed intubations than the single-use laryngoscopes, but these differences did not reach statistical significance. CONCLUSIONS: Of the laryngoscopes tested, the standard reusable Macintosh laryngoscope performed best. The Europa was the best single-use laryngoscope. Some single-use laryngoscopes tested were significantly inferior to the Macintosh. This raises concern over their use in clinical practice, particularly if intubation is difficult.

Anaesthesia in an adult with Rubenstein-Taybi syndrome using the ProSeal laryngeal mask airway.

We report the anaesthetic management of an adult with Rubenstein-Taybi syndrome. This rare congenital syndrome is characterized by severe learning difficulties, cardiac abnormalities, gastrooesophageal reflux, and cranio-facial abnormalities with the likelihood of difficult intubation. A ProSeal laryngeal mask airway was used to ventilate the patient for eye surgery.

A comparison of post mortem findings with post hoc estimated clinical diagnoses of patients who die in a United Kingdom intensive care unit.

OBJECTIVE: To determine the accuracy of clinical diagnosis compared to post mortem findings in intensive care patients. DESIGN: A retrospective and blinded review of medical records. SETTING: A nine-bed combined high dependency and intensive care unit in a district general hospital in Gloucester, England. PATIENTS AND PARTICIPANTS: Ninety-seven patients who died on the intensive care unit and subsequently underwent post mortem examination. RESULTS: Suspected cause of death and main clinical diagnoses were determined and compared with findings at post mortem examination. All patients in whom a discrepancy was found had their cases reviewed to determine the significance of the discrepancy using the Goldman classification of post mortem discrepancies. Between June 1996 and May 1999 there were 1718 admissions with 252 deaths (14.7%), where 102 post mortem examinations were performed (40.5%). Five patients were not studied. Of the 97 patients, 4 (4.1%) had Goldman I discrepancies and 19 (19.6%) had Goldman II discrepancies. Complete agreement between pre and post mortem diagnosis was found in 74 (76.3%). Discrepancies fell into four main groups; unrecognised haemorrhage (7 patients), myocardial infarction (5), thromboembolic disease (5) and infectious complications (4). CONCLUSIONS: This study reveals that in an intensive care unit important diagnostic discrepancies were found in 19.6% of patients who underwent a post mortem examination. In a fifth of these (4.1%), survival may have been adversely affected. Haemorrhage was the most commonly missed diagnosis. Despite technological advances in intensive care medicine the post mortem examination continues to have an important role in auditing clinical practice and diagnostic performance.