Anaesthesia
-
We report the case of a patient with severe chronic obstructive pulmonary disease who underwent local resection of a carcinoma of the rectum under spinal anaesthesia. Although the patient was keen to avoid general anaesthesia and to have the operation under a spinal anaesthetic, pre-operative assessment showed that he could not lie flat. ⋯ Continuous positive airway pressure at 7.5 cmH(2)O was successfully used to facilitate breathing during surgery under spinal anaesthesia. A combination of regional anaesthesia and continuous positive airway pressure via a facemask is easy to use and may be a useful option in the management of these challenging patients.
-
We report six patients with unexpected difficult airways who underwent tracheal intubation using the Laryngeal Mask Airway CTrach. All these patients had failed orotracheal intubation using direct laryngoscopy and gum elastic bougie placement. Fibreoptic bronchoscopy failed in two of these patients due to blood and secretions in the airway. This report describes the successful use of this new intubating laryngeal mask in these cases, all of whom were intubated on the first attempt with this new device.
-
Using ultrasound imaging, the optimal angle for needle insertion during caudal epidural injection in children was estimated. After general anaesthesia, ultrasonography was performed at the sacral hiatus in 130 children aged 2-84 months positioned in the lateral position. ⋯ The median [range] calculated optimal angle for the needle was 21.0 [10-38] degrees. We conclude that the needle should be inserted at about 20 degrees to the skin to avoid puncture of the bone and potential intra-osseous injection.