In the October 2008 BJA...
Anaesthesia and chronic fatigue syndrome Anaesthetizing a patient with chronic fatigue syndrome or idiopathic environmental intolerance can be a challenge. These patients often present with a list of drugs to which they are ‘sensitive’. The article by Fisher and Rose (pages 486–91) describes their experience with these patients who were referred to an anaesthesia allergy clinic, and reviews the literature relating to these problems. They found no evidence that any particular drug or technique is associated with increased risk and little evidence of an allergic basis. These patients may present armed with information gained from websites that appears to be anecdotal rather than evidence based. The authors conclude with a series of recommendations for handling the psychological and clinical challenges these patients present.Calcium-channel blockers and anaesthesia Calcium-channel blockers are used widely for the treatment of hypertension and ischaemic heart disease but their role in the perioperative period is unclear. There is only limited evidence suggesting a cardio-protective role perioperatively. In a study of 1000 patients presenting for aortic surgery, Kertai and colleagues (pages 458–65) found an increased 30-day mortality associate with dihydropyridine calcium-channel blocker use. The authors caution against the use of these agents in patients for aortic surgery. This view is discussed in the accompanying Editorial (Biccard and Howell, pages 439–41), in which the role of observational and retrospective data analysis is qualified. It is clear that this subject requires a well-controlled prospective study.
Video laryngoscopy There are a number of new devices for tracheal intubation which make use of video technology to give the anaesthetists a ‘live’ display of the larynx. Three articles in this month's BJA look at different aspects of this technology in clinical practice. Kim and colleagues (pages 531–4) compared the use of a Macintosh or video laryngoscope in over 200 children and found equal or a better view with the video laryngoscope but a longer intubation time. Howard-Quijano and colleagues (pages 568–72) assessed the use of a video laryngoscope or standard laryngoscope in a group of novice anaesthetists and found an improved, but not perfect, rate of successful intubations. Movement of the cervical spine during tracheal intubation with in-line stabilization was examined radiologically (Maruyama et al., pages 563–7) to compare the effect of a video or a Macintosh laryngoscope. The authors found a decreased upper-cervical spine movement with the video laryngoscope.
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Related articles in BJA:
- Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome
- M. McD. Fisher and M. Rose
BJA 2008 101: 486-491.[Abstract] [Full Text] - Dihydropiridine calcium-channel blockers and perioperative mortality in aortic aneurysm surgery
- M. D. Kertai, C. M. Westerhout, K. S. Varga, G. Acsady, and J. Gal
BJA 2008 101: 458-465.[Abstract] [Full Text] - Calcium channel blockers, beta-blockers, and perioperative cardiovascular stability
- B. M. Biccard and S. J. Howell
BJA 2008 101: 439-441.[Extract] [Full Text] - GlideScope® video laryngoscope: a randomized clinical trial in 203 paediatric patients
- J.-T. Kim, H.-S. Na, J.-Y. Bae, D.-W. Kim, H.-S. Kim, C. S. Kim, and S. D. Kim
BJA 2008 101: 531-534.[Abstract] [Full Text] - Video-assisted instruction improves the success rate for tracheal intubation by novices
- K. J. Howard-Quijano, Y. M. Huang, R. Matevosian, M. B. Kaplan, and R. H. Steadman
BJA 2008 101: 568-572.[Abstract] [Full Text] - Randomized cross-over comparison of cervical-spine motion with the AirWay Scope or Macintosh laryngoscope with in-line stabilization: a video-fluoroscopic study
- K. Maruyama, T. Yamada, R. Kawakami, and K. Hara
BJA 2008 101: 563-567.[Abstract] [Full Text]
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