Misidentification of the CTM in female patients is common and its localization is less precise in those who are obese. This has implications for the likely success of invasive airway access via the CTM.
There may be a role for single-use laryngeal mask airways with concerns about inability to adequately sterilise laryngeal mask airways to eradicate prion proteins. A single-blinded prospective randomised controlled trial was conducted to compare the clinical performance of the single-use AMBU ® LMA with the reuseable LMA Classic. There was no difference in time to insertion, successful insertion at first attempt, oropharyngeal leak pressure, haemodynamic response to insertion or complications of placement. The AMBU ® LMA was easier to insert. There was a suggestion of reduced postoperative sore throat and pharyngeal trauma for the AMBU ® LMA group. The AMBU ® LMA is a viable alternative to the LMA Classic for airway management in spontaneously breathing patients.
The design of the Laryngeal Mask Airway CTrach™ combines the fibreoptic viewing capability of the Glidescope™ and the ability for ventilation of the Fastrach™. We conducted a prospective randomised trial comparing the intubation characteristics of the CTrach™ and Glidescope™ to investigate the difference in clinical performance for airway management during anaesthesia. One-hundred-and-six patients with normal airways were recruited and randomly assigned to the CTrach™ or Glidescope™ group. A standardised anaesthesia and airway management protocol was used. The time to intubation was significantly shorter for the Glidescope™ compared to the CTrach™ (43±22 vs. 73±36 s, P <0.001). The success rates of intubation within first and three attempts were significantly higher for Glidescope™. There was no apparent difference in complications of device insertion. Our results suggest that during elective management of normal airways, the time to intubation with the Glidescope™ is significantly shorter than the CTrach™. Further studies are required to compare these devices in patients with difficult airways.
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We report a case of a parturient who was well antenatally but presented with oliguria following delivery. The possibility of post-partum pre-eclampsia was obscured by simultaneous post-partum haemorrhage. Ergometrine was given and she suffered an eclamptic seizure shortly after. We discuss the diagnostic difficulties presented by simultaneous presentation of post-partum pre-eclampsia and haemorrhage and the likelihood that ergometrine precipitated eclampsia in a patient at risk. While ergometrine is an effective drug for the management of uterine atony, its potential role in precipitating eclampsia must be considered.
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