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Efficacy and safety of the laryngeal mask airway vs Guedel airway following tracheal extubationPurpose: To compare the safety and efficacy of the laryngeal mask airway (LMA) with the Guedel airway during the recovery period. Methods: In a prospective randomised trial in the Post Anesthesia Care Unit (PACU), 52 patients (ASA I and 2) were randomised to receive either a laryngeal mask airway (LMA: n = 26) or a Guedel airway (n = 26) during the recovery period after middle ear surgery. Ease of airway maintenance was graded and the presence of coughing was noted. Peripheral arterial oxygen saturation (SpOt) was measured continuously by pulse oximetry in the PACU. Readings were taken on arrival (time 0) and for five minutes afterwards. Results: There was no difference in sex, age, weight or incidence of smoking between the two groups. In the LMA group 25 patients required no airway manipulation and only one patient required repositioning of the LMA. In the Guedel group severe difficulty maintaining the airway was experienced in two patients, moderate difficulty in five patients and mild difficulty in 12 patients. Seven patients required no airway manipulation. The LMA group showed higher ease of airway maintenance scores, (P = <0.0001) and less coughing (P = 0.0496). At time 0 and at one minute the LMA group had higher median SpO 2 (97% and 97%) than the Guedel group (95% and 96%), (P = 0.0002 and 0.0362). There was no further difference in SpO 2. Conclusions: The LMA provides easier airway maintenance, less coughing and initially higher median SpO 2 when compared with the Guedel airway in the recovery period.Objectif : Comparer la s6curit6 et I'efficacit6 du masque laryng6 (ML) ~ celles de la canule oropharyng6e de Guedel pendant la r6cup6ration de I'anesth&ie. M&hode : Lors d'un essai prospectif et randomis6 ~ la salle de r~veil (SR), 52 patients (ASA Iet II) ont 6t6 r6par-tis au hasard et on leur a install6 un masque laryng6 (ML : n = 26) ou une canule oropharyng& de Guedel (n = 26) pendant la r&up&ation d'une chirurgie ~ I'oreille moyenne. On a cot6 la facilit~ ~ maintenir I'ouverture des voies a&iennes et not4 la pr&ence de toux. La saturation du sang art&iel p&iph&ique en oxyg6ne (SpO2) a &6 mesur~e de fagon continue par oxym&rie pulsEe ~ la SR. Les mesures ont 6t6 enregistr~es ~ I'arriv6e (temps 0) et cinq minutes plus tard. R~sultats : II n'y avait pas de diff&ence de sexe, d'~ge, de poids ou d'incidence de tabagisme entre les deux groupes. Dans le groupe ML, un seul patient a eu besoin d'un repositionnement du ML et non les 25 autres. Dans te groupe Guedel, il y a eu de s&ieuses difficult& fi maintenir I'ouverture des voies a&iennes chez 2 patients, des difficult& mod&&s chez 5 patients et des difficult& mineures chez 12. II n'y a eu aucune manipulation chez 7 d'entre eux. Dans le groupe ML, on a not6 des scores plus 61ev6s quant ~ la facilitfi de maintenir la perm6abilit6 des voies a&iennes, (P = <0,000 f) et moins de toux (P = 0,0496). Au temps 0 et ~ une minute, les patients du groupe ML pr&entaient une S...

ObjectiveTo report outcomes in a recent series of pregnancies in women with Marfan syndrome (MFS).DesignRetrospective case note review.SettingTertiary referral unit (Chelsea and Westminster and Royal Brompton Hospitals).SampleTwenty-nine pregnancies in 21 women with MFS between 1995 and 2010.MethodsMultidisciplinary review of case records.Main outcome measuresMaternal and neonatal mortality and morbidity of patients with MFS and healthy controls.ResultsThere were no maternal deaths. Significant cardiac complications occurred in five pregnancies (17%): one woman experienced a type–A aortic dissection; two women required cardiac surgery within 6 months of delivery; and a further two women developed impaired left ventricular function during the pregnancy. Women with MFS were also more likely to have obstetric complications (OR 3.29, 95% CI 1.30–8.34), the most frequent of which was postpartum haemorrhage (OR 8.46, 95% CI 2.52–28.38). There were no perinatal deaths, although babies born to mothers with MFS were delivered significantly earlier than those born to the control group (median 39 versus 40 weeks of gestation, Mann–Whitney U–test, P = 0.04). These babies were also significantly more likely to be small for gestational age (24% in the MFS group versus 6% in the controls; OR 4.95, 95% CI 1.58–15.55).ConclusionsPregnancy in women with MFS continues to be associated with significant rates of maternal, fetal, and neonatal complications. Effective pre-pregnancy counselling and meticulous surveillance during pregnancy, delivery, and the puerperium by an experienced multidisciplinary team are warranted for women with MFS.