Introduction After failed mask ventilation and tracheal intubation, guidelines issued by the Difficult Airway Society recommend placing a second generation supraglottic airway device to secure oxygenation. Ultimately, a secure airway can be obtained by tracheal intubation through the supraglottic airway device using a bronchoscope. In this randomised trial, we compared the AuraGain™ with the i‐gel™ as conduit for bronchoscopic intubation under continuous oxygenation performed by a group of anaesthesiologists with variable experience in a general population of patients. Method We randomised one hundred patients who were equally allocated to flexible bronchoscopic intubation through the i‐gel™ or the AuraGain™. In a random order, 25 anaesthesiologists each performed four intubations, two using the i‐gel™ and two using the AuraGain™. Our primary outcome was ‘total time for airway management’; i.e. total time from manually reaching the SAD to successful FBI confirmed at the end of the first inspiratory downstroke on the capnography curve. Results In total, 87% (95% CI, 79%–92%) of the patients were successfully intubated through the allocated supraglottic airway device. There was no difference in total time for airway management between the i‐gel™ and the AuraGain™ (199 vs. 227 s, p = .076). However, there was a difference in time for placement of the i‐gel™, compared to the AuraGain™, (37 vs. 54 s, p < .001). There were nine failed intubations in the AuraGain™ group compared to four in the i‐gel™ group (p = .147). Conclusion We found no difference in total time for airway management between using the i‐gel™ and using the AuraGain™.

WHAT THIS PAPER ADDSThis study demonstrates the reliability of a fully automated portable device for performing toe pressure measurements in a bedside outpatient clinic setting without specialised personnel. Previous studies have shown acceptable agreement with laboratory standards, but those studies were either performed in a laboratory setting or did not follow recommendations for studies of diagnostic accuracy. The device discussed herein showed reasonable agreement with strain gauge plethysmography in diagnosing chronic limb threatening ischaemia (CLTI). This device is capable of excluding CLTI and can function as a crude screening device.Objective: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. Methods: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. Results: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 AE 16 mmHg for right limbs and 10 AE 16 mmHg for left limbs (p < .001). Conclusion:The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.

15. Bubner B, Gase K, Baldwin IT. No TitleTwo-fold differences are the detection limit for determining transgene copy numbers in plants by real-time PCR.