Anaesthesia
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A new approach to internal jugular vein catheterisation in the neck (the 'very high' approach) was used in 335 patients over a 12-month period. The success rate was 100% and there were no complications. It proved to be an easy technique to learn and may be particularly useful in difficult and emergency situations.
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This study was designed to evaluate the routine use of a gum elastic bougie for tracheal intubation. The median time to intubation with the gum elastic bougie while simulating an 'epiglottis only' view was only 10 s longer than the time taken during conventional intubation with an optimum view. ⋯ There was no significant difference in the incidence of postoperative sore throat and hoarseness between the two groups. We recommend that anaesthetists should use the gum elastic bougie whenever a good view of the glottis is not immediately obtained.
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The laryngeal mask airway was inserted in 10 cadavers. At postmortem the chest was opened and an infusion set primed with a dilute barium solution was inserted into the oesophagus and ligated in place. ⋯ The cricoid pressure was able to stop the flow of fluid into the oesophagus. This demonstrates that cricoid pressure is effective in preventing reflux at intragastric pressures which are encountered clinically and the presence of the laryngeal mask airway does not compromise this.
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Clinical and fibreoptic assessment of positioning of the size 1 laryngeal mask airway was performed in 50 infants. A clinically patent airway was obtained in 47 patients at the first attempt, but perfect positioning, as assessed by fibreoptic laryngoscopy, was found in only 22 instances. Despite an airway initially patent, delayed airway obstruction occurred in 12 infants. It is concluded that clinical airway patency does not guarantee ideal positioning of LMA in infants, and that care should be taken to ensure continued airway patency because of the tendency of the LMA position to deteriorate in this group of children.