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Second Attempt (second + attempt)
Selected AbstractsA left paraglossal approach for oral intubation in children scheduled for bilateral orofacial cleft reconstruction surgery , a prospective observational studyPEDIATRIC ANESTHESIA, Issue 2 2009INDU SEN MD Summary Background:, Children with orofacial cleft defects are expected to have difficult airways. Conventional midline laryngoscopic approach of oral intubation can lead to iatrogenic tissue trauma. In this study, we evaluated the feasibility of left paraglossal laryngoscopy as a primary technique for airway management in these children. Methods:, After institutional ethical committee approval and informed consent, we enrolled 21 children with uncorrected bilateral lip and palate deformities (BL CL/P). Anesthesia was induced with halothane (0.5,4%) in 100% oxygen. After obtaining intravenous access, fentanyl 1.5 ,g·kg,1 and atracurium 0.5 mg·kg,1 were administered. Endotracheal intubation was performed with Miller's straight blade laryngoscope, introduced using left paraglossal approach. Difficulty of intubation was scored according to modified Intubation Difficulty Scale. Results:, Data consists of 21 children (15 males and six females), mean age 1.31 ± 1.18 years and weight 9.27 ± 2.57 kg. Laryngoscopic view obtained was CL II (7[33.3%]) and CL I (14[66.6%]) respectively (Figure 1). All the children could be easily intubated using left paraglossal approach, only 2/3 of them needed optimal external laryngeal manipulation to help achieving it. Though intubation could be done in the first attempt in 19 children, two infants (9½ and 11 months) required one size smaller endotracheal tube and were intubated in the second attempt using left paraglossal approach. Perioperative course was uneventful in all the children. Figure 1. ,Distribution of Intubation Difficulty scale (IDS) Score in BL CL/P patients. n (%) IDS: 0 (intubation without difficulty), IDS: 1 (slight difficulty; OELM applied/additional intubation attempt), IDS: >5 (Moderate to Major difficulty), IDS: = , (Impossible intubation). Conclusion:, Keeping in mind midline tissue support loss in cleft deformities, we propose routine use of left paraglossal laryngoscopic approach for intubating children with uncorrected BL CL/P anomalies. [source] Insertion and use of the LMA SupremeÔ in the prone position,ANAESTHESIA, Issue 2 2010A. M. López Summary We investigated whether insertion of an LMA SupremeÔ and its use for maintenance of anaesthesia is feasible in the prone position. Forty adult patients positioned themselves prone and were given propofol until the Bispectral Index was < 50. A size-4 LMA Supreme was inserted by experienced anaesthetists. Ease of insertion, ease of ventilation, efficacy of seal, ease of gastric tube insertion, blood staining, postoperative sore throat, and other complications were recorded. Insertion was successful at the first and second attempt in 37 (92.5%) and 3 (7.5%) patients, respectively. The mean (SD) insertion time was 21 (15) s. Oropharyngeal leak pressure was greater in females than males (29 (4) vs 25 (4) cmH2O, respectively, p = 0.01). Adequate ventilation was achieved in all patients. Gastric tube placement was successful in all patients. The frequency of blood staining and sore throat was 7.5% each. No other complications were noted. We conclude that use of the LMA Supreme in the prone position by experienced users is feasible. [source] The Laryngeal Mask Airway SupremeTM, a single use laryngeal mask airway with an oesophageal vent.ANAESTHESIA, Issue 1 2009A randomised, anaesthetised patients, cross-over study with the Laryngeal Mask Airway ProSealTM in paralysed Summary The LMA SupremeTM is a new extraglottic airway device which brings together features of the LMA ProSealTM, FastrachTM and UniqueTM. We test the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSealTM and the LMA SupremeTM in paralysed anesthetised patients. Ninety-three females aged 19,71 years were studied. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. Oropharyngeal leak pressure and fibreoptic position were determined during cuff inflation from 0 to 40 ml in 10 ml increments. Gastric tube insertion was attempted if there was no gas leak from the drain tube. First attempt and overall insertion success were similar (LMA ProSealTM, 92% and 100%; LMA SupremeTM 95% and 100%). Guided insertion was always successful following failed digital insertion. Oropharyngeal leak pressure was 4,8 ml higher for the LMA ProSealTM over the inflation range (p < 0.001). Intracuff pressure was 16,35 cm higher for the LMA ProSealTM when the cuff volume was 20,40 ml (p < 0.001). There was an increase in oropharyngeal leak pressure with increasing cuff volume from 10 to 30 ml for both devices, but no change from 0 to 10 ml and 30,40 ml. There were no differences in the fibreoptic position of the airway or drain tube. The first attempt and overall insertion success for the gastric tube was similar (LMA ProSealTM 91% and 100%; LMA SupremeTM 92% and 100%). We conclude that ease of insertion, gastric tube placement and fibreoptic position are similar for the LMA ProSealTM and LMA SupremeTM in paralysed, anaesthetised females, but oropharyngeal leak pressure and intracuff pressure are higher for the LMA ProSealTM. [source] ,LAYIN' LOW AND SAYIN' NUFFIN': AUSTRALIA'S POLICY TOWARDS BRITAIN'S SECOND BID TO JOIN THE EUROPEAN ECONOMIC COMMUNITY (1966,67)AUSTRALIAN ECONOMIC HISTORY REVIEW, Issue 2 2006Andrea Benvenuti Australia; European Union; international trade; trade policy; United Kingdom This article examines the problems and challenges which confronted the Australian government in its response to Britain's second attempt to join the European Economic Community (EEC) in 1967. While an adequate body of literature exists on Australia's policy towards Britain's first application to the EEC (1961,63), the Australian government's response to the 1967 bid has been completely ignored by historians. This article, therefore, aims to make a historical contribution to the understanding of Australia's policy towards Britain's ,turn to Europe'. [source] Temporal variation in breeding and cone size selection by three species of crossbills Loxia spp. in a native Scots pinewoodJOURNAL OF AVIAN BIOLOGY, Issue 3 2010Ron W. Summers The breeding biology and cone size selection of crossbills was studied mainly during 1995 to 2002 at Abernethy Forest, Scotland, an ancient native Scots pine Pinus sylvestris wood, where only a single crossbill species, the Scottish crossbill Loxia scotica, was assumed to occur and to be adapted to feed on seeds in Scots pine cones. However, three crossbill species (common Loxia curvirostra, Scottish and parrot crossbills Loxia pytyopsittacus) nested in some years, with the parrot crossbill being the most abundant. Most nests were in old large pines, with the three crossbill species not differing in their use of tree size or stand density for nesting. The mean clutch and brood sizes were 3.8 and 2.9, and their mean survivals were 86 and 74%, respectively, with no significant differences among species. The timing of breeding differed between species, with parrot crossbills breeding earliest (median date 21 March, including second attempts) and common crossbills breeding last (median date 21 April), probably in response to the differing accessibility of Scots pine seeds to these species. The difference in the time of breeding may reduce mixed mating. Crossbills foraged preferentially on trees with small cones when the cones were closed. Small cones had thinner scales than large cones, suggesting that the preference for small cones was related to higher feeding rates on these cones when cones are closed. Such a preference was also found for captive crossbills with the Scottish crossbill showing a more pronounced preference for smaller cones than the larger-billed parrot crossbill. However, crossbills selected larger cones within trees and trees with larger cones once the cones opened in April. Such a shift occurred presumably because variation in scale thickness has little impact on seed accessibility once cones open, and larger cones have larger and more seeds. The greater ability of parrot crossbills to exploit seeds in closed Scots pine cones allowed parrot crossbills to start breeding earlier and to have young when seeds were most accessible. Only after the cones opened were the smaller-billed common crossbills able to easily access seeds and to start breeding. The time of breeding of Scottish crossbills was intermediate between common and parrot crossbills, and they probably had an intermediate ability to exploit Scots pine cones. The reason why there were few Scottish crossbills nesting in Abernethy Forest remains a puzzle, considering that native pine wood is assumed to be the ancestral habitat to which the Scottish crossbill is adapted. The breeding season for all crossbills ended in June, when most of the seed from a given cone cohort was shed. This is when starved broods were found, not associated with bad weather. [source] Implementing a Smoking Cessation Program for Pregnant Women Based on Current Clinical Practice GuidelinesJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2002Lynne Buchanan APRN, PhDArticle first published online: 24 MAY 200 Purpose To describe the U.S. Department of Health and Human Services clinical practice guideline for treating tobacco use and dependence and demonstrate how the guideline was utilized in a pilot program for a small sample of pregnant women (n=20) to help them decrease smoking. Data Sources A convenience sample of 20 pregnant women was recruited from a health maintenance organization at their initial prenatal contact either by telephone or in person. A comparison group of pregnant women (n=28) was used for analysis of outcomes. Conclusions Clinical results showed better outcomes for women in the pilot program when compared to a similar group who did not participate in the program. There was a statistically significant difference between the two groups in average number of cigarettes smoked per day at delivery and two weeks after delivery with pilot program participants reporting less smoking (p<.05). Women in both groups showed a pattern of returning to smoking after delivery of the baby. Implications for Practice Although a few tobacco users achieve permanent abstinence in first or second attempts, the majority continue to use tobacco for many years and typically cycle through many lapse and relapses before permanent abstinence. Ambulatory care systems need to be developed and funded to treat tobacco use and dependence over the life span. Recognition of the chronic nature of the problem and development of long term care delivery systems are needed to assist clients to achieve goals of permanent abstinence and better personal and family health. This cycle of lapse and relapse before permanent abstinence is typical and demonstrates the chronic nature of tobacco use and dependence and the need for long term follow-up. [source] | ||||||||||