ABSTRACTS

laryngeal mask airway

The laryngeal mask airway: Clinical appraisal in 250 pat ients Maltby JR, Loken RG, Watson NC Can J Anesth 37,5:509-513 Jul 1990

The laryngeal mask airway (LMA) is a new device intermediate in de- sign between an oropharyngeal air- way and an endotracheal tube. A 12- ram ID tubular oropharyngeal airway is fused at its distal end to an oval silicone mask with an inflatable rim that provides an airtight seal around the larynx. To assess the efficacy of the LMA, its use was studied on 250 patients aged 14 to 87 years and weighing 39 to 110 kg who were un- dergoing a variety of surgical pro- cedures ranging from ten to 280 min- utes' duration. Obstetrical patients, patients suspected of having full stomachs, those undergoing esopha- geal or gastric surgery, or those prone for more than one hour were ex- cluded. The LMA was administered by three anesthetists with no prior experience with the device under light inhalat ional anesthesia both with and wi thout neuromuscular blockade. Blind insertion was suc- cessful in 75% of patients at first at- tempt. The LMA was abandoned in 12 patients. The LMA could not be passed in two patients because of small mouths. The airway was unsat- isfactory in ten patients, with ob- struction and large air leak in five pa- tients, respectively. Advantages of the LMA over endotracheal intuba- tion include elimination of the possi- bility of esophageal or bronchial in- tubation. The device can be inserted with light levels of anesthesia with or without neuromuscular blockade. The LMA is reusable, and the poly- vinylchloride tracheal tube is dispos- able. However, the LMA should not be used in patients with full stom- achs, as it does not protect the air- way from aspiration of foreign mate- rial. /Editor's note: The fact that pa-

t ients who need emergency active airway management often have full s tomachs and are at high risk for vomit ing and aspiration precludes the future use of this device in the field or emergency department be- cause, in the awake patient, it will probably s t imulate a gag reflex, in- creasing the incidence of vomiting and aspiration.]

Jeffrey Hill, MD

nongonococcal urethritis; chlamydia; ciprofioxacin

Ciprofloxacin compared with doxycycl ine for nongonococcal urethrit is Hooton TM, Rogers ME, Medina TG, et al JAMA 264:1418-1421 Sep 1990

A prospective, randomized, double- blind trial was conducted to compare the efficacy of two high-dose regi- mens of ciprofloxacin (750 mg and 1,000 mg twice daily for seven days) with a conventional regimen of dox- ycyc l ine (100 mg twice daily for seven days) for t reatment of non- gonococca l ure thr i t i s (NGU) and eradication of urethral Chlamydia trachomatis infection. Of the 178 men enrolled, 152 were fully assess- able with re-examination and recul- ture at two to three days, two weeks, and four weeks after compl iance with treatment. Resolution rates of NGU were comparable at 50% in all treatment groups at all three follow- up visits, which is lower than that generally reported with doxycycline. Among the 60 patients with initial cultures positive for Chlamydia, C trachomatis was reisolated during the follow-up period in 11 (52%) of the 21 patients treated with 1,000 mg ciprofloxacin compared with none of the ten doxycycline-treated patients. Twelve of the post-treatment C tra- chomatis isolates were available for serotyping, and all were the same se- rotype as the initial infecting strain. Reinfection is an unlikely explana-

tion for the reoccurrence, as rates of unprotected sexual intercourse after t reatment were comparable among the three groups. Doxycycline was comparable to high-dose ciproflox- acin in efficacy of treatment of NGU and was superior in eradication of chlamydial urethritis. In addition, the cost of doxycycline is substan- tially less than ciprofloxacin. It was concluded that ciprofloxacin in doses as high as 2 g daily is inadequate in t he t r e a t m e n t of c h l a m y d i a l urethritis in men, often resulting in relapsing infections.

Merle Miller, MD

trauma, alcohol

Alcohol and the adolescent t rauma population Hicks BA, Morris JA, Bass SM, et ar J Pediatr Surg 25:944-949 Sep 1990

A retrospective analysis of 878 ad- olescents (16- to 20-year-olds) se- lected from 6,172 trauma cases over a 56-month period was performed. Of the 467 patients who had blood alco- hol content (BAC) measured, 209 (45%) had positive alcohol levels. The BAC-positive group was more predominantly male (84% vs 64%), slightly but significantly older (mean age, 18.5 years vs 18.0 years), and had been injured later in the day (average, 2.7 hours later) than the BAC-nega- tive group. The BAC-positive group also had slightly but significantly higher Injury Severity Scores and s l igh t ly but s ign i f i can t ly lower Glasgow Coma Scores. However, there were no significant differences in TRISS-predicted survival, actual survival, number of ICU days, num- ber of hospital days, or transfusion r e q u i r e m e n t s b e t w e e n the two groups. It was concluded that alcohol plays a significant role in adolescent injuries but does not affect injury outcome.

Michael Kohn, MD

164/705 Annals of Emergency Medicine 20:6 June 1991