Anaesthesia
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Randomized Controlled Trial
Inflation with air via a facepiece for facilitating insertion of a nasogastric tube: a prospective, randomised, double-blind study.
Insertion of a nasogastric tube is a routine procedure but during anaesthesia it is often difficult and time consuming. One hundred and sixty adults undergoing elective surgery under general anaesthesia were randomly divided into two groups. ⋯ Insertion of the nasogastric tube was successful in 75/78 (96%) following inflation compared with 54/80 (68%) without inflation (p<0.001). In four patients receiving inflation, a fibreoptic endoscope was passed as far as the upper oesophageal sphincter; this revealed opening of the upper oesophageal sphincter during inflation.
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The objective of this study was to compare linear and non-linear analysis of heart rate variability (HRV) in terms of correlation with haemodynamic fluctuation during induction of general anaesthesia. Pre-operatively, HRV was estimated by the MemCalc method in 114 patients scheduled for general anaesthesia. ⋯ As an index of non-linear analysis of HRV, ultra short-term entropy (UsEn) correlated better with blood pressure fluctuation than did the ratio of the power of low frequency component of HRV to that of high frequency component (LF/HF). In contrast, although LF/HF significantly correlated with heart rate increase caused by tracheal intubation, the correlation between UsEn and heart rate fluctuation was not significant.
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An 82-year-old ASA 2 patient underwent routine sub-Tenon's block for cataract surgery. One minute after injection of the local anaesthetic, the patient had a generalised tonic-clonic seizure and developed refractory ventricular fibrillation; subsequent resuscitation was unsuccessful. With no evidence for intravascular injection, the lack of structural brain abnormalities, and the most striking feature on post mortem examination being severe triple vessel coronary artery disease, it was concluded that this was primarily cardiac in origin; however, the possibility of brainstem anaesthesia should also be considered.
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The risk of endobronchial intubation during laparoscopy because of displacement of the tip of the tracheal tube is a well known problem in adults. Laparoscopy in children is increasingly performed, but there are no data available regarding the above problem. ⋯ Maximal displacement of the tip of the tracheal tube tip in cm was 0.5+(0.05xage (years)) for 20 degrees head-down tilt, 0.6+(0.09xage (years)) for capnoperitoneum alone, and 1.2+(0.11xage (years)) for 20 degrees head-down tilt with capnoperitoneum. In no patients did endobronchial intubation occur with the tracheal tube placed according to the intubation depth marking.