Anaesthesia
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A study was undertaken to compare the size of tracheal tube used for paediatric anaesthesia derived from either the diameter of the distal phalanx of the little or index finger, or from a standard formula (age in years/4 + 4.5 mm). The results showed that the diameter of the terminal phalanx was a poor predictor of the external diameter of the tube that provided the best fit. ⋯ The mean (SD) figures were 5.61 (0.75) and 5.70 (0.67) mm for the formula and the chosen tracheal tube, respectively. The use of the diameter of the terminal phalanx of either the little or the index finger is an unreliable measurement for the prediction of the tracheal tube size in paediatrics.
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When volatile anaesthetics are used in a closed breathing system it is usually assumed that inflow of anaesthetic to the system matches uptake by the patient. Early laboratory reports on the interactions between sevoflurane and soda lime cast doubt on that assumption. We have measured the loss of sevoflurane, desflurane and isoflurane from a closed breathing system and found no differences of consequences.
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Splanchnic ischaemia is thought to be of central importance in the development of multi-organ failure and hence death in critically ill patients. It has been suggested that the arterial to gastric intramucosal pH gradient and the difference in partial pressure of carbon dioxide between gastric mucosa and arterial blood are more sensitive markers of splanchnic ischaemia than gastric intramucosal pH itself and thus should be predictors of mortality in the critically ill. We studied 62 critically ill patients within 6 h of admission to the intensive care unit and found no significant difference at 0, 12 or 24 h after admission to the study in either the arterial to gastric intramucosal pH gradient or the difference in partial pressure of carbon dioxide between gastric mucosa and arterial blood between survivors and nonsurvivors. We conclude that in contrast to gastric intramucosal pH neither the arterial to gastric intramucosal pH gradient nor the difference in partial pressure of carbon dioxide between gastric mucosa and arterial blood distinguish survivors from nonsurvivors.
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An 11-year-old boy suffered an inadvertent dural puncture during placement of an epidural catheter for postoperative analgesia. He developed symptoms of mild headache only, but severe and protracted orthostatic nausea and dizziness, which eventually resolved completely following epidural blood patch. ⋯ The reported incidence of headache following dural puncture in children is low. It may be that the manifestations are different from those of adults and that the true incidence of symptoms related to leakage of cerebrospinal fluid is higher in children than currently recognised.
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Letter Case Reports
The potential for extravasation using a new five lumen catheter.