IntroductionSupraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session.MethodsFour different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS.ResultsThe longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes.ConclusionLaypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.
Understanding how consciousness and cognitive function return after a major perturbation is important clinically and neurobiologically. To address this question, we conducted a three-center study of 30 healthy humans receiving general anesthesia at clinically relevant doses for three hours. We administered a pre-and post-anesthetic battery of neurocognitive tests, recorded continuous electroencephalography to assess cortical dynamics, and monitored sleep-wake activity before and following anesthetic exposure. We hypothesized that cognitive reconstitution would be a process that evolved over time in the following sequence: attention, complex scanning and tracking, working memory, and executive function. Contrary to our hypothesis, executive function returned first and electroencephalographic analyses revealed that frontal cortical dynamics recovered faster than posterior cortical dynamics. Furthermore, actigraphy indicated normal sleep-wake patterns in the post-anesthetic period. These recovery patterns of higher cognitive function and arousal states suggest that the healthy human brain is resilient to the effects of deep general anesthesia.
Our data are congruent with previous observations made with TCD under similar experimental conditions. Such observations support the notion that acousto-optic monitoring yields valid real-time measures of changes in CBF in humans. Further validation against other quantitative measures of CBF would be appropriate.
Background: "Chest compressions only" resuscitation (CCOR) has been suggested one method of increasing laypersons attendance providing bystander resuscitation, avoiding mouth-to-mouth (MTM) ventilation and improving patients' outcome. In prolonged CCOR without rescue breaths and a non-cardiac origin, neurological outcome is very much dependent on oxygenation. As an alternative to MTM we investigated laypersons ability to operate supraglottic airway devices (SAD) in the manikin, following illustrated on-site instruction. Methods: Laypersons were handed a bag containing either an LMAS or an LT, a bag-mask-valve device (BMV), a syringe prefilled with air, and an instruction manual consisting of four annotated diagrams displaying the correct use of either the Laryngeal Mask Supreme™ (LMAS) or the Laryngeal Tube™ (LT). They were then asked to perform and ventilate a manikin as displayed. The process was evaluated in quantity and quality. Results: A total of 299 laypersons were enrolled. 145 applicants in the LMAS (96.7%) and 143 in the LT (96%) group inserted the SAD in the right direction. Previous BLS education was not associated with a higher rate of success (LMAS (P=0.85) vs. LT (P=0.63)). The most common error identified was the depth of insertion (LT 40.9% (n=61) vs. LMAS 32.7% (n=49); P=0.18). No significant difference was found with regard to positioning the devices twisted or reversed (LT 4.7% (n=7) vs. LMAS 6% (n=9); P=0.79). Conclusion: In simulated setting laypersons can achieve appropriate skills and understanding for both SADs using a simple instruction manual. Application of SADs may be improved by a better labeling, the quality of the instruction sheet and a reduction in steps required. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h
The haemodynamic changes during epidural anaesthesia and following the administration of dihydroergotamine (DHE; 10 µg/kg i.v.) were studied in 7 dogs (epidural group). Epidural anaesthesia was associated with reductions in mean arterial, mean pulmonary arterial and mean right atrial pressures. Femoral flow was increased by 119.9 ± 35.0% and femoral resistance fell by 62.7 ± 7.2%. All these changes were abolished by additional administration of DHE during epidural anaesthesia. In a second group of dogs (control group, n = 8) with intact innervation, i.e. without epidural block, DHE (10 µg/kg i.v.) also decreased femoral flow and increased femoral resistance which, however, was significantly less pronounced (p < 0.01). It is concluded that DHE in epidural anaesthesia constricts arteriolar resistance vessels, mainly within the blocked areas.
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