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C Verghese

Publications and source records attributed to C Verghese.

At least 19 recordsLinked to original sources
PubMed2005

The Glidescope system: a clinical assessment of performance.

The Glidescope is a new videolaryngoscope. It has a digital camera incorporated in the blade which displays a view of the vocal cords on a monitor. This allows the placement of a tracheal tube to be visualised. We describe its performance in 50 patients who required orotracheal intubation for elective surgery. Two investigators performed 25 intubations each. Intubation with the Glidescope was successful in 47 of the 50 cases. The three failures occurred early in the series and were attributed to the initial learning curve. The success rate after the first eight patients in each series was 100%. The median (IQR [range]) time to intubation was 40 (30-55 [15-105]) s. The Glidescope provided a grade I view of the glottis in 44 cases and a grade II view in six cases. The view of the larynx was improved in almost half (23) of the cases. The Glidescope improved the view by one grade in 22 and by two grades in one patient. We conclude that the Glidescope is an effective device for tracheal intubation and provides an improved view of the larynx. Further clinical studies are necessary to evaluate its role in airways that are difficult to manage.

Adult↗
PubMed2002

Randomized crossover comparison of the proseal with the classic laryngeal mask airway in unparalysed anaesthetized patients.

BACKGROUND: The ProSeal is a wire-reinforced laryngeal mask airway with an additional drain tube that leads to the distal tip of the laryngeal cuff. The design should improve the seal with the larynx. METHODS: The ProSeal and classic laryngeal mask airways were compared in 180 patients in a randomized crossover study. Patients were anaesthetized without neuromuscular blocking drugs. RESULTS: The ProSeal took more time and more attempts to insert successfully than the classic laryngeal mask airway. Insertion was successful on the first attempt in 81% of cases with the ProSeal and 90% with the classic laryngeal mask airway. The ProSeal required more air to achieve an intracuff pressure of 60 cm H2O (6 ml more for size 4 and 12 ml more for size 5). Laryngeal seal pressure was better with the ProSeal than the classic laryngeal mask airway. Median seal pressure was 29 cm H2O with the ProSeal and 18 cm H2O with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 20 cm H2O in 87% of patients with the ProSeal and 41% with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 40 cm H2O in 21% of patients with the ProSeal and in none of the patients with the classic laryngeal mask. Once placed, the ProSeal remained a stable and effective airway. Gastric tube insertion through the drain tube was attempted in 147 cases and was successful in 135 (92%). CONCLUSION: The ProSeal is more difficult to insert than the classic laryngeal mask airway but allows positive pressure ventilation more reliably than the classic laryngeal mask airway.

Adolescent↗
PubMed2000

Resolution of ST-segment elevation after streptokinase therapy in anterior versus inferior wall myocardial infarction.

BACKGROUND: Resolution of ST-segment elevation is the best bedside predictor of myocardial reperfusion. HYPOTHESIS: This study was conducted to examine the resolution of ST-segment elevation after streptokinase therapy in anterior versus inferior acute myocardial infarction (MI) and to corroborate it with echocardiographic and coronary angiographic data. METHODS: The study population consisted of 70 patients, 35 each in the anterior and inferior MI groups. The electrocardiograms (ECGs) were recorded before, on completion of, and on Days 1 and 2 post streptokinase therapy. The resolution of ST segment determined from post-streptokinase ECGs was compared between the two groups and correlated with echocardiographic and coronary angiographic data. RESULTS: On completion of and on Day 1 post streptokinase therapy, ST-segment resolution in both groups was not significantly different. On Day 2 post streptokinase therapy, resolution of the ST segment per lead was significantly lower in anterior than that in inferior MI (61 +/- 21% anterior vs. 77 +/- 21% inferior, p 0.003). The number of patients with akinesis of infarct-related ventricular wall was significantly higher (17 anterior vs. 7 inferior, p 0.02), and left ventricular ejection fraction was significantly lower in anterior MI (39 +/- 7% anterior vs. 48 +/- 8% inferior, p < 0.01). There was no significant difference in coronary angiographic data. One patient in each group demonstrated normal coronary arteries. CONCLUSIONS: The resolution of ST-segment elevation on the completion of and on Day 1 post streptokinase therapy was comparable between anterior and inferior MI. The significantly less frequent resolution of ST-segment elevation in anterior MI on Day 2 post streptokinase could be due to more akinesis, larger infarct size, and worse systolic function rather than due to failure to open the infarct-related vessel.

Coronary Angiography↗
PubMed2000

The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent.

We describe a new laryngeal mask airway (LMA) that incorporates a second tube placed lateral to the airway tube and ending at the tip of the mask. The second tube is intended to separate the alimentary and respiratory tracts. It should permit access to or escape of fluids from the stomach and reduce the risks of gastric insufflation and pulmonary aspiration. It can also determine the correct positioning of the mask. A second posterior cuff is fitted to improve the seal. A preliminary crossover comparison with the standard mask in 30 adult female patients showed no differences in insertion, trauma or quality of airway. At 60 cm H2O intracuff pressure, the new LMA gave twice the seal pressure of the standard device (P < 0.0001) and permitted blind insertion of a gastric tube in all cases. It is concluded that the new device merits further study.

Adult↗
PubMed1999

Pulmonary airway resistance with the endotracheal tube versus laryngeal mask airway in paralyzed anesthetized adult patients.

BACKGROUND: The hypothesis that airway resistance is less with the laryngeal mask airway than with the endotracheal tube was tested. METHODS: Thirty-six paralyzed, anesthetized adult patients with no respiratory disease (American Society of Anesthesiologists physical status 1-3; age, 18-80 yr) were randomly allocated (9 men, 9 women in each group) to receive either a size-4 laryngeal mask airway or an endotracheal tube (men, 9-mm ID; women, 8-mm ID). A pulmonary monitor with flow transducer and esophageal balloon was used to measure peak airway pressure and mean airway resistance (device resistance plus pulmonary airway resistance) at three different tidal volumes (5, 10, and 15 ml/kg). Device resistance was measured in vitro with the distal end of the endotracheal tube or laryngeal mask airway open to the atmosphere and using the same ventilator settings. Pulmonary airway resistance was derived by subtracting the mean device resistance from the mean airway resistance. RESULTS: Peak airway pressure, mean airway resistance, device resistance, and pulmonary airway resistance were greater for the endotracheal tube (all P < 0.0001). CONCLUSIONS: The laryngeal mask airway triggers less bronchoconstriction than does the endotracheal tube in paralyzed anesthetized adult patients. This may have implications for maintaining intraoperative pulmonary function and reducing the risk for atelectasis and pulmonary infection.

Adolescent↗
PubMed1999

Airway management.

The last decade of the millennium has witnessed the introduction of new extratracheal airway devices for use in fasted patients undergoing ambulatory anaesthesia. A growing awareness of the potential of such devices in the difficult airway has contributed to their increasing use.

Journal Article↗
PubMed1998

Clinical assessment of the single use laryngeal mask airway--the LMA-unique.

We conducted a clinical comparison of the laryngeal mask airway (LMA) and the new single use PVC LMA (LMA-Unique) in 100 fasted adult patients undergoing elective surgery. Patients were allocated to one of two groups: group 1 (n = 50) was managed by two consultants and group 2 by two trainee anaesthetists. Airway management was randomized prospectively within each group, and cuff pressure in both devices was maintained at a maximum of 50 mm Hg with upward size substitution if leaks persisted during intermittent positive pressure ventilation (IPPV). Insertion with the recommended technique was successful in all patients (85 first attempt). One patient (group 1) required four attempts for insertion of the LMA-Unique and in one patient (group 2) the LMA-Unique was replaced by a tracheal tube because of persistent leaks during IPPV. In 99 patients IPPV was uneventful. The adjusted mean volume of air for cuff inflation in the LMA-Unique was significantly less in group 1 (P = 0.0013). At fibreoptic laryngoscopic examination, the vocal cords or arytenoids, or both, could be seen in 92% of patients in group 1 and in 90% of patients in group 2. Immediate throat soreness was reported in four patients in group 1 and in seven in group 2. The results suggest that the LMA-Unique was similar in clinical performance to the LMA.

Adult↗
PubMed1998

Laryngeal mask airway and incidence of gastro-oesophageal reflux in paralysed patients undergoing ventilation for elective orthopaedic surgery.

We have studied the incidence of gastro-oesophageal reflux associated with the laryngeal mask airway (LMA) in 82 paralysed patients undergoing ventilation for elective orthopaedic surgery. Anaesthesia was managed by skilled LMA users. A pH-sensitive probe was passed nasally into the oesophagus before induction and recordings made during five phases of anaesthesia. Anaesthesia was induced with propofol and fentanyl and maintained with 0.5-1.5% isoflurane and nitrous oxide in oxygen. Neuromuscular block was produced with vecuronium and the train-of-four count maintained at < or = 1. Towards the end of surgery, neuromuscular function was allowed to recover spontaneously. All LMAs were inserted at the first attempt and ventilation was successful in all patients. There were no adverse airway events. Mean oesophageal pH values during each phase of anaesthesia were: before insertion 5.88 (SD 0.77), placement 5.85 (0.74), maintenance 5.89 (0.73), emergence 5.71 (0.78) and removal 5.82 (0.75). There were no reflux events (pH < 4.0) during any phase of anaesthesia. We conclude that the incidence of gastro-oesophageal reflux is low in paralysed patients undergoing ventilation for elective orthopaedic surgery when antagonism of neuromuscular block is avoided. The validity of these findings for unskilled LMA users is unknown.

Adult↗