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PURPOSE: Perioperative hypothermia is still a common occurrence, and it can be difficult to measure a patient's core temperature accurately, especially during regional anesthesia, with placement of a laryngeal mask airway device, or postoperatively. We evaluated a new disposable double-sensor thermometer and compared the resulting temperatures with those of a distal esophageal thermometer and a bladder thermometer in patients undergoing general and regional anesthesia, respectively. Furthermore, we compared the accuracy of the thermometer between regional and general anesthesia, since forehead microcirculation might differ between the two types of anesthesia. METHODS: We assessed core temperature in 36 general anesthesia patients and 20 patients having regional anesthesia for orthopedic surgery. The temperatures obtained using the double-sensor thermometer were compared with those obtained with the distal esophageal thermometer in the general anesthesia population and those obtained with the bladder thermometer in regional anesthesia patients. RESULTS: In our general anesthesia patients, 90% (95% confidence interval [CI] 85 to 95) of all double-sensor values were within 0.5°C of esophageal temperatures. The average difference (bias) between the esophageal and double-sensor temperatures was -0.01°C. In patients undergoing regional anesthesia 89% (95% CI 80 to 97) of all double-sensor values were within 0.5°C of bladder temperatures. The average difference (bias) between the bladder and double-sensor temperatures was -0.13°C, limits of agreement were -0.65 to 0.40°C. CONCLUSIONS: In a perioperative patient population undergoing general or regional anesthesia, the accuracy of the noninvasive disposable double-sensor thermometer is comparable with that of the distal esophageal and bladder thermometers in routine clinical practice. Furthermore, the sensor performed comparably in patients undergoing regional and general anesthesia.
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Equipos Desechables , Termómetros , Anestesia de Conducción , Anestesia General , Temperatura Corporal , HumanosRESUMEN
INTRODUCTION: The GlideScope(®) video laryngoscope has a 60° angled blade and the blade of the Truview PCD™ video laryngoscope has an optical lens that provides a 46° refraction of the viewing angle. Despite successful results using the GlideScope in adults, few studies have been published regarding its use in pediatric patients. We therefore tested our joint primary hypothesis that the GlideScope and the Truview PCD video laryngoscopes provide superior visualization to direct laryngoscopy and are non-inferior regarding time to intubation. METHODS: One hundred thirty-four patients (neonate to ten years of age, American Society of Anesthesiologists physical status I-III) scheduled for general surgical procedures were randomized to tracheal intubation using the Truview PCD or GlideScope video laryngoscope or direct laryngoscopy (Macintosh blade). The laryngoscopic view was scored using the Cormack-Lehane scale. Time to intubation (defined as the time from the moment the device entered the patient's mouth until end-tidal CO2 was detected) and the number of attempts were recorded. RESULTS: The Cormack-Lehane views attained using the GlideScope (P > 0.99) and Truview PCD (P = 0.18) were not superior to the views attained with direct laryngoscopy. Furthermore, the view attained using the GlideScope was significantly worse than that attained using direct laryngoscopy (P < 0.001). Fewer patients showed Cormack-Lehane grade I views with the GlideScope than with the Truview PCD (14% vs 82%, respectively; 95% confidence interval [CI] -91% to -46%). The observed median [Q1, Q3] times to intubation were: 39 [31, 59] sec, 44 [28, 62] sec, and 23 [21, 28] sec with the GlideScope, Truview PCD, and direct laryngoscopy, respectively, with median differences of 14 sec (95% CI 7 to 26, GlideScope - direct laryngoscopy) and 17 sec (95% CI 6 to 28, Truview PCD - direct laryngoscopy). CONCLUSION: The Cormack-Lehane views attained using the GlideScope and the Truview PCD video laryngoscopes were not superior to views attained using direct laryngoscopy. Visualization with the GlideScope was significantly worse than with direct laryngoscopy. Use of the GlideScope and Truview PCD systems should be restricted to patients with specific indications.