A comparison of the clinical use of the Laryngeal Tube S and the ProSeal Laryngeal Mask Airway by first-month anaesthesia residents in anaesthetised patients.

The Laryngeal Tube S and the LMA-ProSeal are supraglottic instruments with an improved airway seal and a drainage tube to protect against regurgitation and to facilitate passage of a gastric tube. We compared the feasibility of these two instruments in a randomised, controlled clinical trial. One hundred and sixty patients were randomly allocated to undergo insertion of a Laryngeal Tube S (n = 82) or an LMA-ProSeal (n = 78). All insertions were carried out by first-month anaesthesia residents. Success rates were not significantly different: Laryngeal Tube S 89%, LMA-ProSeal 95%. There was also no significant difference in leak pressure or insertion time. Insertion time decreased significantly when we compared the first with the last 10 insertions. Gastric tube placement was successful in all patients in the Laryngeal Tube S group, but failed in 12 patients in the LMA-ProSeal group (p < 0.001). Dysphagia was reported by 22% of Laryngeal Tube S group and 3% of LMA-ProSeal group (p = 0.001). These findings demonstrate the applicability of the devices and a learning effect in the hands of anaesthesia residents with limited experience.

[Neostigmine treatment of acute pseudo-obstruction of colon (Ogilvie syndrome)]. / Neostigmine voor de behandeling van acute pseudo-obstructie van het colon (Ogilvie-syndroom).

In a 77-year-old male patient with Parkinson's disease and with acute pseudo-obstruction of the colon (Ogilvie's syndrome) conservative therapy was ineffective. Neostigmine was recently shown to be effective and safe for the treatment of Ogilvie's syndrome. Intravenous neostigmine treatment caused a prompt clinical and radiological response in the patient. Early recognition of the condition and prompt neostigmine treatment if conservative measures fail is important to reduce the risk of bowel perforation.

[Risk factors for the development of phlebitis in peripheral infusions]. / Risicofactoren voor het ontstaan van flebitis bij een perifeer infuus.

OBJECTIVE: To study the incidence and risk factors of development of phlebitis caused by peripheral infusions. DESIGN: Prospective, descriptive. SETTING: Westindies Hospital, The Hague, the Netherlands. METHODS: For all 348 patients given infusions in a 6-week period the development of phlebitis, if any, and the contributing factors were studied. RESULTS: Phlebitis developed in 136 patients (39%), after an average of 2.9 days (range: 1-14). Risk factors were female sex, earlier phlebitis, insertion on the ventral surface of the forearm and administration of antibiotics via the infusion. These factors were not interdependent. No correlation was found between development of phlebitis and the size of the needle. CONCLUSION: Development of phlebitis depends on a number of factors. Timely removal of the infusion can prevent the development of phlebitis. Infusions should preferably be administered via the hand.