Anaesthesia
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A Combitube airway was inserted into 40 patients undergoing general anaesthesia. A rigid cervical collar was then used to immobilise the neck of each patient. ⋯ In 18/40 patients (45%), blood was present on the Combitube after removal. Reducing the volume of air injected into the proximal balloon of the Combitube appeared to reduce the incidence of airway trauma during insertion.
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Critical care services appear to face increasing demand. To attempt to identify factors which may predispose to such increases in demand, the patients and their treatment were reviewed. The patients' ages, referring specialty and their risk of hospital mortality were recorded on admission. ⋯ The patients' mean ages increased by 1 year per year. The number of patients referred from general surgery consistently increased. The proportion of patients receiving vasoactive drugs and pulmonary artery catheters declined as did the duration of respiratory and renal support.
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Case Reports
Regional anaesthesia with a subarachnoid microcatheter for caesarean section in a parturient with aortic stenosis.
We present a woman in her first pregnancy, with known aortic stenosis prior to conception, who successfully underwent regional anaesthesia for an elective Caesarean section using a subarachnoid microcatheter. The anaesthetic management of patients with aortic stenosis requiring noncardiac surgery is a complex and contentious matter, particularly when the situation is compounded by the physiological changes accompanying pregnancy and delivery. This is the first reported use of a subarachnoid microcatheter in such a patient. The choice of technique is discussed and compared with other options for providing anaesthesia.