Appropriate size of laryngeal mask.
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Equipment Design↗
Biomedical subjects
J Sartain
Publications and source records attributed to J Sartain.
Pharyngolaryngeal, neck, and jaw discomfort after anesthesia with the face mask and laryngeal mask airway at high and low cuff volumes in males and females.
BACKGROUND: There is controversy over (1) the relative incidence of sore throat between the face mask (FM) and laryngeal mask airway (LMA), (2) the efficacy of LMA intracuff pressure reduction as a mechanism for minimizing sore throat, and (3) the relative incidence of sore throat with the LMA between males and females. In a randomized double-blind study, the authors compared laryngopharyngeal, neck, and jaw discomfort with the FM and LMA at high and low cuff volumes in males and females. METHODS: Three hundred adult patients were randomly assigned to three equal-sized groups for airway management: (1) the FM, (2) the LMA with a fully inflated cuff (LMA-High), or (3) the LMA with a semi-inflated cuff (LMA-Low). Anesthesia was administered with propofol, nitrous oxide, oxygen, and isoflurane. In the FM group, a Guedel-type oropharyngeal airway and jaw thrust were used only if necessary. In the LMA groups, cuff inflation was achieved with either 15 or 30 ml for the size 4 (females) and 20 or 40 ml for the size 5 (males). The LMA was removed when the patient was awake. Patients were questioned 18-24 h postoperatively about surgical pain, sore throat, sore neck, sore jaw, dysphonia, and dysphagia, and about whether they were satisfied with their anesthetic. RESULTS: The incidence of sore throat was lower in the FM (8%) than the LMA-High (42%) and LMA-Low (20%) groups (both: P < or = 0.02). The incidence of sore neck was higher for the FM (14%) than the LMA-High group (6%; P = 0.05) but similar to the LMA-Low group (8%). The incidence of sore jaw was higher in the FM (11%) than the LMA-High (3%) and LMA-Low (3%) groups (both: P = 0. 02). There were no differences among groups for surgical pain or dysphonia. The incidence of dysphagia was lower in the FM (1%) than the LMA-High group (11%; P = 0.003), but similar to the LMA-Low group (1%). The incidence of sore throat and dysphagia was lower in the LMA-Low group than the LMA-High group for both males and females (all: P < or = 0.04). There were no differences in discomfort levels between males and females in any group. Two patients from the FM group and one from the LMA-High group were not satisfied with their anesthetic. These complaints were unrelated to postoperative morbidity. CONCLUSION: The LMA causes more sore throat and dysphagia but less jaw pain than the FM. Sore throat and dysphagia are more common with the LMA if the initial cuff volume is high. There are no differences in discomfort levels between males and females. However, these discomforts do not influence patient satisfaction after LMA or FM anesthesia.
Adult↗
Comparison of the use of a propofol infusion in cardiac surgical patients with normal and low cardiac output states.
OBJECTIVES: This study compared the hemodynamic effects of a propofol infusion with fentanyl analgesia in patients undergoing cardiac surgery with normal and low cardiac output states. Low cardiac output was defined as a cardiac index less than 2.5 L/min/m2 with a minimum pulmonary capillary wedge pressure of 7 mmHg. DESIGN: A prospective and open study. SETTING: A single center cardiothoracic unit within a teaching hospital. PARTICIPANTS: Patients were assigned to group P, poor cardiac output or group N, normal cardiac output, after thermodilution pulmonary artery catheter assessments. INTERVENTIONS: Both groups received a propofol infusion, 8 mg/kg/hr, until induction of anesthesia, followed by 4 mg/kg/hr until the intensive care unit. Fentanyl, 15 micrograms/kg, and pancuronium, 0.15 mg/kg, were administered after induction. The lungs were ventilated with oxygen. MEASUREMENTS AND MAIN RESULTS: Hemodynamic assessments were repeated at intervals until cardiopulmonary bypass. Changes within and between groups were compared using t tests on percentage change from baseline. Group N had significantly greater decreases in cardiac index, stroke volume, and left ventricular stroke work index than group P. There were comparable decreases in mean arterial pressure on induction of anesthesia, 14% and 8% in group N and group P, respectively. In both groups, right ventricular ejection fraction was unchanged. CONCLUSIONS: The use of a propofol infusion for induction and maintenance of anesthesia in patients with low cardiac output states undergoing cardiac surgery is not contraindicated.
Analgesics, Opioid↗
Comparison of propofol and fentanyl anaesthesia in coronary artery versus valve surgery.
Total intravenous anaesthesia with propofol and fentanyl was used in 23 patients undergoing coronary artery and 16 patients undergoing valve surgery and the haemodynamic effects in the two groups were compared. Baseline values showed that the valve surgery group had a higher mean heart rate, pulmonary artery wedge pressure and pulmonary artery pressure and smaller mean stroke volume than the coronary artery surgery group. In both groups, heart rate, arterial pressure, pulmonary artery wedge pressure, pulmonary artery pressure and cardiac index decreased during surgery. In the valve surgery group there were greater percentage decreases in heart rate, mean arterial pressure and diastolic arterial pressure. Overall, propofol and moderate-dose fentanyl anaesthesia was no more detrimental to the haemodynamics in patients undergoing valve surgery when compared to those undergoing coronary artery surgery.
Aged↗
Propofol and fentanyl anaesthesia for patients with low cardiac output state undergoing cardiac surgery: comparison with high-dose fentanyl anaesthesia.
We have compared the haemodynamic effects of an infusion of propofol 8 mg kg-1 h-1 followed by 4 mg kg-1 h-1 and fentanyl 15 micrograms kg-1 (group 1) with midazolam 3-6 mg and fentanyl 60 micrograms kg-1 (group 2) in patients with a low cardiac output state undergoing cardiac surgery. Heart rate was lower in group 1 throughout the period before cardiopulmonary bypass. There were no significant differences between the groups in other measured variables. Arterial pressure decreased in both groups after induction, by 21% in group 1 and 18% in group 2. Thermodilution assessment of right ventricular ejection fraction was unchanged. Myocardial contractility was not affected adversely. Patients in group 1 who received an infusion of propofol and a smaller dose of fentanyl awakened sooner and the trachea was extubated earlier.
Adult↗
Superiority of the internal jugular over the subclavian access for temporary dialysis.
We studied angiographically the access route 1-27 months after the insertion temporary dialysis catheters in 52 patients: 32 subclavian and 20 internal jugular. The two groups were statistically similar with respect to age, sex and race. The subclavian catheters were left in for a mean of 11.5 days (2-22) while the internal jugular ones were inserted for 15.8 days (5-25; p = 0.0015). One hundred percent of the internal jugular patients were free of any venogram abnormalities in their venous access return. In marked contrast, 50% of the subclavian sites had mild to severe stricutures with 90% having 70-100% occlusion of the subclavian vein. Six patients had bilateral severe strictures. The long-term stricture rate of subclavian catheters in the subclavian vein was unacceptably high compared to the internal jugular route.
Catheterization, Central Venous↗