Anaesthesia
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The rôle of the laryngeal mask airway for thyroid and parathyroid surgery was studied in 97 consecutive patients. In 50% the technique combined electrical stimulation of the recurrent laryngeal nerve with visualisation of vocal cord movement via a fibreoptic bronchoscope. Stimulation was required in 10% to assist in identifying recurrent laryngeal nerve position during difficult surgical dissection. ⋯ Tracheal intubation was required for seven patients but in only two of these was intubation unplanned. The incidence of postoperative recurrent laryngeal nerve dysfunction was zero. These data suggest that the technique offers a safe alternative in airway management and may provide advantages in terms of preservation of recurrent laryngeal nerve function.
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Clinical Trial
Safety and efficacy of the laryngeal mask airway. A prospective survey of 1400 children.
A survey of laryngeal mask airway usage in 1400 infants and children by ten trainee anaesthetists was undertaken to provide information about insertion and complication rates using the standard insertion technique and a limited range of standardised anaesthetic techniques. Placement was successful in 90% (1258/1400) at the first attempt, 8% (112/1400) at the second attempt and 2% (29/1400) required an alternative technique of insertion. One patient vomited during insertion and the procedure was abandoned, but aspiration did not occur. ⋯ There was a significant decrease in problems with increasing experience (p < 0.001). There was no major morbidity associated with use of the device. We conclude that the laryngeal mask provides a safe and effective form of airway management for infants and children in the hands of supervised anaesthesia trainees both for spontaneous and controlled ventilation using either isoflurane or total intravenous anaesthesia.
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A 13-year-old boy presenting for correction of bat ears was anaesthetised with thiopentone and suxamethonium, the administration of which was followed by jaw spasm, poor peripheral perfusion (without cyanosis) and marked tachycardia. The procedure was abandoned, dantrolene and Ringer lactate IL were given intravenously and the patient regained consciousness 1 h later. ⋯ Despite a peak serum myoglobin of 58.000 micrograms.l-1 and peak urinary level of 446,000 micrograms.l-1, no renal impairment occurred. Subsequent testing for susceptibility to malignant hyperthermia proved positive for the patient and four other members of the family.
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Case Reports
Management of Caesarean delivery in the presence of a large pelvic vascular malformation.
Caesarean section is associated with significant cardiovascular disturbances. We present a patient known to have a large pelvic arteriovenous malformation who underwent elective Caesarean section. To assist in the monitoring and management of the anticipated haemodynamic changes a flow directed pulmonary artery catheter with the capacity to allow continuous cardiac output measurement was used.
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We have examined the predictability of inspired desflurane concentration during low-flow anaesthesia using a to-and-fro breathing system. Twenty-two adult patients requiring mechanical ventilation of the lungs during surgery took part in the study. Using a fresh gas flow of 1 l.min-1, the ratio of inspired desflurane concentration to desflurane vaporizer setting was found to be approximately 0.75 after 9 min of anaesthesia and at 2 l.min-1 fresh gas flow the ratio was approximately 0.9 after 2 min of anaesthesia. These ratios were maintained throughout the procedure, except for a few minutes following each change in vaporizer setting.