Anaesthesia
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A PAXpress (Vital Signs Inc., Barnham, UK) airway device was placed in 50 adult ASA grade I and II patients undergoing elective surgery under general anaesthesia. The alignment of the PAXpress to the larynx was scored fibreoptically. The patients were then intubated blindly through the PAXpress and the adjusting manoeuvres required for successful intubation and complications of intubation observed. ⋯ When the fibreoptic alignment score was between 2 and 4 intubation was achieved predominantly with the extension manoeuvre (20/30, 66%) rather than the flexion manoeuvre (1/30, 3%) or the neutral position (5/30, 16%). Blood staining was observed in 20 patients. We conclude that blind tracheal intubation through PAXpress has a moderately good success rate and a high incidence of mucosal trauma. 'Extension' is the predominant adjusting manoeuvre required for blind tracheal intubation, especially when the alignment of the PAXpress to the larynx is poor.
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The effect of flow on the filtration performance of six different types of filter intended for use in paediatric anaesthesia was measured by challenging the filters with sodium chloride particles at five different flows: 6, 10, 15, 20 and 30 l x min(-1). Twenty-five unused samples of each filter type were evaluated. The pressure drop across each filter was measured at the same flows as those used to measure penetration. ⋯ Allowing for the variation in pressure drop, the penetration of particles increased fairly linearly as flow increased for all six filter types. The increase in penetration per unit increase in flow varied from 0.11 to 0.82% per litre per minute. Over the range of flows studied, the increase in penetration with flow is fairly predictable.
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Post dural puncture headache can be a debilitating complication of epidural and subarachnoid anaesthesia for a new mother. In a survey of 18,337 epidurals and 5021 subarachnoid blocks performed for obstetric procedures over a 23-year period in a district general hospital maternity unit, there were 167 recognised accidental dural punctures after epidurals (0.91%), with 147 patients (88%) developing post dural puncture headache. In addition there were 52 post dural puncture headaches after subarachnoid blocks (1.04%). Successful management of accidental dural puncture and post dural puncture headache requires adherence to clear policies and protocols, with close follow-up of patients by an experienced obstetric anaesthetist.
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Direct laryngoscopy is performed regularly in paediatric anaesthetic practice for the purpose of intubating a patient's trachea. A minimum illumination of 700 lux at a distance of 20 mm has been suggested in a draft standard for laryngoscopes from the International Organization for Standardization. We investigated the minimum and optimum illumination required by anaesthetists during laryngoscopy. ⋯ Two of the six combinations could produce more than 700 lux. In all, 78% and 54% of anaesthetists considered 700 lux too bright with a halogen and xenon bulb, respectively. Our study suggests that the proposed standard of 700 lux may possibly be too bright.