3 research outputs found
Effect of removal of AuraOnceâ„¢ laryngeal mask in awake or deep anaesthesia: a randomized controlled trial
Background: The manufacturer Ambu® recommends that the AuraOnce™ laryngeal mask be removed once the patient is fully awake. Studies have shown benefit in removal of the laryngeal mask airway while a patient is deeply anaesthetized. Current evidence is inconclusive, as to which approach is preferable and safer in adults.
Methods: one hundred and sixteen adult patients were randomly assigned to two groups of 58. For the deep arm; The AuraOnceTM laryngeal mask was removed after attaining an end tidal minimum alveolar concentration of Isoflurane of 1.15%. Occurrence of airway complication(s) (One or more of the following; Airway obstruction requiring airway manipulation; Laryngospasm; Desaturation to 90% or less on pulse oximetry) was noted until the subject was fully awake (appropriate response to command) in the post-anaesthesia care unit. For the awake arm; The AuraOnceTM laryngeal mask was removed on attaining an end tidal minimum alveolar concentration of Isoflurane of \u3c0.5% and an appropriate response to command or obtaining appropriate response to command irrespective of end tidal concentration. Occurrence of airway complication(s) in theatre and post anaesthesia care unit was recorded. Time to theatre exit was recorded for both groups.
Results: Baseline demographic characteristics were similar between the groups. More airway complications were encountered in the Deep arm - 13 (22.4%) relative to the Awake arm -5 (8.6%), this was found to be statistically and clinically significant, P value P=0.040, odds ratio 3.0622; 95% CI, 1.0139 to 9.2483.
Conclusion: The removal of the AuraOnceTM laryngeal mask while the patient is still deeply anaesthetised is not as safe as or safer than awake removal
Effect of removal of AuraOnceTM laryngeal mask in awake or deep anaesthesia: a randomized controlled trial
Background: The manufacturer Ambu\uae recommends that the
AuraOnce\u2122 laryngeal mask be removed once the patient is fully
awake. Studies have shown benefit in removal of the laryngeal mask
airway while a patient is deeply anaesthetized. Current evidence is
inconclusive, as to which approach is preferable and safer in adults.
Methods: one hundred and sixteen adult patients were randomly assigned
to two groups of 58. For the deep arm; The AuraOnceTM laryngeal mask
was removed after attaining an end tidal minimum alveolar concentration
of Isoflurane of 1.15%. Occurrence of airway complication(s) (One or
more of the following; Airway obstruction requiring airway
manipulation; Laryngospasm; Desaturation to 90% or less on pulse
oximetry) was noted until the subject was fully awake (appropriate
response to command) in the post-anaesthesia care unit. For the awake
arm; The AuraOnceTM laryngeal mask was removed on attaining an end
tidal minimum alveolar concentration of Isoflurane of <0.5% and an
appropriate response to command or obtaining appropriate response to
command irrespective of end tidal concentration. Occurrence of airway
complication(s) in theatre and post anaesthesia care unit was recorded.
Time to theatre exit was recorded for both groups. Results: Baseline
demographic characteristics were similar between the groups. More
airway complications were encountered in the Deep arm - 13 (22.4%)
relative to the Awake arm -5 (8.6%), this was found to be statistically
and clinically significant, P value P=0.040, odds ratio 3.0622; 95% CI,
1.0139 to 9.2483. Conclusion: The removal of the AuraOnceTM laryngeal
mask while the patient is still deeply anaesthetised is not as safe as
or safer than awake removal
Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact
Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally.
Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen\u27s kappa \u3e0.6 indicative of good inter-rater agreement.
Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties.
Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives