Epidural volume extension (EVE) via a combined spinal-epidural (CSE) technique is the enhancement of a small-dose intrathecal block by epidural saline boluses. In this prospective, randomized, double-blind study, we compared the EVE technique with single-shot spinal anesthesia with respect to its se

The LMA Protector™ is the latest CE marked single use supraglottic airway device. This airway device provides access and functional separation of the respiratory and digestive tracts. There are two ports (male, female ports) to provide suction in the laryngeal region and insertion of the gastric tube. The aim of our study is to assess the ease of use, airway quality, device positioning, airway leak and complications associated with initial clinical experience in LMA Protector™ usage. This is an initial investigation of LMA Protector™ airway device. We conducted a preliminary assessment in the anaesthetised women who underwent minor gynaecological procedures with spontaneous ventilation in order to evaluate the performance of the airway device. Insertion was successful on first and second attempts in 23 (88.5%) and 3 (11.5%) respectively. Median [IQR (range)] insertion time was 19 [17-21(14-58)] seconds. Airway leak pressure was 25.5 [23-29(21-30] cmH2O. On fibreoptic examination via the device, vocal cords were visible in all 26 patients. There were no alternative airway use or airway manipulations required during maintenance of anaesthesia. Six patients had sore throat 24 h after procedures and there was no dysphagia or hoarseness. This pilot study of the LMA protector shows that the device is easily inserted with fast insertion time, providing a reliable and adequate airway seal. Clinicaltrials.gov Registration NCT02531256 . Retrospectively registered on August 21, 2015.

Background: Technological advances in healthcare have enabled patients to participate in digital self-assessment, with reported benefits of enhanced healthcare efficiency and self-efficacy. This report describes the design and validation of a patient-administered preanaesthesia health assessment digital application for gathering medical history relevant to preanaesthesia assessment. Effective preoperative evaluation allows for timely optimization of medical conditions and reduces case cancellations on day of surgery. Methods: Using an iterative mixed-methods approach of literature review, surveys and panel consensus, the study sought to develop and validate a digitized preanaesthesia health assessment questionnaire in terms of face and criterion validity. A total of 228 patients were enrolled at the preoperative evaluation clinic of a tertiary women’s hospital. Inclusion criteria include: age ≥ 21 years, scheduled for same-day-admission surgery, literacy in English and willingness to use a digital device. Patient perception of the digitized application was also evaluated using the QQ10 questionnaire. Reliability of health assessment questionnaire was evaluated by comparing the percentage agreement of patient responses with nurse assessment. Results: Moderate to good criterion validity was obtained in 81.1 and 83.8% of questions for the paper and digital questionnaires respectively. Of total 3626 response-pairs obtained, there were 3405 (93.4%) concordant and 221 (6.1%) discrepant response-pairs for the digital questionnaire. Discrepant response-pairs, such as ““no/yes” and “unsure/yes”, constitute only 3.7% of total response-pairs. Patient acceptability of the digitized assessment was high, with QQ10 value and burden scores of 76 and 30%, respectively. Conclusions: Self-administration of digitized preanaesthesia health assessment is acceptable to patients and reliable in eliciting medical history. Further iteration should focus on improving reliability of the digital tool, adapting it for use in other languages and incorporating clinical decision tools.