Progressive protocol in the bowel management of spinal cord injuries.

Research into bowel management in spinal cord injury is sparse. Specifically, the use of laxatives in this group, while widespread, is not supported by research evidence. A prospective study in which baseline and intervention data were collected from each subject was undertaken with 17 individuals. The baseline was the routine method of bowel management in the study unit. The intervention was the use of a progressive protocol which allowed the use of physical interventions and rectal stimulants prior to the use of laxative therapy if required. Though the response of individuals varied, the number of successful bowel management episodes employing laxatives was significantly less in the intervention phase, the proportion of glycerine suppository uses which were successful was significantly greater, the use of manual evacuation was significantly reduced and the duration of bowel management episodes was significantly less. These findings suggest that use of laxatives in bowel management is not essential for all newly spinal cord injured individuals, while the use of physical interventions in this population may be beneficial. The variable response of individuals to the progressive protocol highlights the need for individual assessment in the area of bowel. The findings of this small study must be validated by a larger study

Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis

Experienced anaesthetists can be confronted with difficult or failed tracheal intubations. We performed a systematic review and meta-analysis to ascertain if the literature indicated if videolaryngoscopy conferred an advantage when used by experienced anaesthetists managing patients with a known difficult airway. We searched PubMed, MEDLINE, Embase and the Cochrane central register of controlled trials up to 1 January 2017. Outcome parameters extracted from studies were: first-attempt success of tracheal intubation; time to successful intubation; number of intubation attempts; Cormack and Lehane grade; use of airway adjuncts (e.g. stylet, gum elastic bougie); and complications (e.g. mucosal and dental trauma). Nine studies, including 1329 patients, fulfilled the inclusion criteria. First-attempt success was greater for all videolaryngoscopes (OR 0.34 (95%CI 0.18-0.66); p = 0.001). Use of videolaryngoscopy was associated with a significantly better view of the glottis (Cormack and Lehane grades 1 and 2 vs. 3-4, OR 0.04 (95%CI 0.01-0.15); p < 0.00001). Mucosal trauma occurred less with the use of videolaryngoscopy (OR 0.16 (95%CI 0.04-0.75); p = 0.02). Videolaryngoscopy has added value for the experienced anaesthetist, improving first-time success, the view of the glottis and reducing mucosal trauma