Survey on controversies in airway management among anesthesiologists in the UK, Austria and Switzerland

BACKGROUND

While surveys about anesthesia practice appear regularly in the anesthesia literature, they are usually bound to one country. We compared the approach to specific airway management issues among anesthesiologists from three different European countries.

METHODS

A questionnaire was distributed during the main session of three anesthesia meetings in Austria (A), the UK, and Switzerland (CH). Questions concerned whether anesthesiologists routinely check for risk factors associated with difficult mask ventilation; whether anesthesiologists are used to mask ventilate prior to administering neuromuscular blocking drugs (NMBD); whether anesthesiologists apply cricoid pressure.

RESULTS

We evaluated 266 questionnaires. No significant differences in the frequency of checking predictors were found, except for "age" (UK: 28%, A: 13%, CH:11%, P=0.01). Fewer anesthesiologists from the UK always check mask ventilation before NMBD (UK: 34%, A: 72%, CH: 67%, P<0.001); but they check mask ventilation more often when risk factors are present (UK: 36%, A: 13%, CH: 20%, P=0.004). Very few anesthesiologists from the UK never apply cricoid pressure (UK: 2%, A: 40%, CH: 49%, P<0.001), but almost all of them apply it in case of rapid sequence intubation (UK: 96%, A: 52%, CH:30%, P<0.001).

CONCLUSION

Answers from anesthesiologists in the UK differed significantly from those in A and CH. Anesthesiologists in the UK check mask ventilation after induction less frequently, but they check more often when risk factors of difficult mask ventilation are present. Cricoid pressure seems to remain an important part of the rapid sequence induction technique in the UK, whereas anesthesiologists in Austria and Switzerland rely less on this technique.

[HELLP Syndrome as an indication for liver transplantation]

Liver rupture followed by multiorgan failure is perhaps the most catastrophic complication of the HELLP syndrome (hemolysis, elevated liver function, low platelets). Specific treatment options are currently limited and not routinely clarified. Here, we present a patient successfully managed by an innovative surgical approach consisting of combined total hepatectomy, portacaval shunt, and liver transplantation. A 26-year-old primipara (39th week of gestation) who suffered liver rupture as a complication of HELLP syndrome after delivery underwent a portacaval shunt after total hepatectomy. This combination was sufficient until the patient underwent orthotopic liver transplantation. The patient was discharged from the hospital after a dramatic recovery. Bridging portacaval shunt and consecutive orthotopic liver transplantation represented an effective therapy for this patient and should be considered early as a treatment option in patients with liver rupture complicating severe HELLP syndrome.

Chronic effects of an aminosteroid on microdialytically measured parameters after experimental middle cerebral artery occlusion in the rat

The effects of the neuroprotective aminosteroid U74006F (tirilazad mesylate, Freedox) were monitored microdialytically in rat cortex during three 4h periods beginning immediately, 25h and 49h after permanent middle cerebral artery occlusion. Either U74006F or vehicle only was administered 15 min, 2h, 6h, 12h and 24h after operation. The dialysate was analysed for on-line pH, ascorbic acid, uric acid, glucose and lactate. The efficacy of post-ischaemic treatment was shown by: a) lesion volume 53h after operation was significantly smaller in U74006F-treated animals; b) microdialytic findings were very similar to those found previously with pre-ischaemic drug application (reduction in release of ascorbic acid, uric acid and lactate, increased pH); c) an effect of U74006F on lactate release could still be seen on days 2 and 3; and d) increases in uric acid on days 2 and 3, possibly reflecting delayed cell death, were smaller in aminosteroid treated animals.