Anaesthesia
-
We have investigated the suitability of the HemoCue photometer to measure the concentration of haemoglobin in suction fluid obtained at elective caesarean section in 30 women. Laboratory analysis was used as a gold standard against which values generated by the HemoCue were compared. ⋯ Mean (SD) total blood loss calculated using these data, combined with the weight of the swabs, was consistently greater than clinical estimation: 768 (496) ml versus 506 (249) ml respectively (p < 0.001). We have found that the HemoCue near patient testing device may be used to estimate blood loss accurately in the suction fluid obtained at elective Caesarean section.
-
Case Reports
Lightwand guided intubation in paediatric patients with a known difficult airway: a report of four cases.
The anaesthetic management of children with craniofacial abnormalities often presents unique challenges because soft tissue and bony abnormalities can affect the airway and influence airway management. We report four paediatric patients with predicted difficult airways due to craniofacial abnormalities. ⋯ All the tracheal intubations were completed using a lightwand on the first attempt in less than 30 s. We consider that lightwand guided intubation technique may be a useful alternative approach to fibreoptic intubation technique in managing the difficult paediatric airway.
-
The response of arterial PO(2) (P(a)O(2)) to airway pressure has been used as a measure of recruitment in mechanically ventilated patients. We hypothesised that mixed venous PO(2) (P(mv)O(2)) directly affects P(a)O(2). Sixteen patients with acute lung injury (ALI, lung injury score > or = 1) on volume-controlled mechanical ventilation (F(I)O(2) 0.40) were studied. ⋯ Changes in P(mv)O(2) contributed to changes in Q(va)/Q(t) in determining changes in P(a)O(2) (p < 0.05). P(mv)O(2) may be an independent determinant of P(a)O(2) during mechanical ventilation for ALI, so that dosing PEEP to recruit the lung should not be guided by arterial blood oxygenation alone. Arterial hypoxaemia with increasing PEEP may improve by reducing PEEP (or increasing tissue O(2) delivery), when the fall in P(mv)O(2) is greater than about 0.133 kPa.
-
We examined the pressures produced by a construction intended for emergency ventilation through a needle cricothyroidotomy. This construction consisted of a standard hospital wall oxygen supply, flowmeter, oxygen tubing and a three-way tap. We measured the flow achieved through a transtracheal catheter and compared the construction to a Manujet jet ventilator and to a Sanders injector. ⋯ The flow through the transtracheal catheter was almost three times higher when the flowmeters were fully opened than when they were opened to the 15 l x min(-1) mark (44.5 vs 15.8 l x min(-1), respectively; p < 0.0001). When the flowmeters were fully opened the pressure measured before the catheter was over four times higher than when they were only opened to the 15 l x min(-1) mark (285.3 vs 66.4 kPa, respectively; p < 0.0001). This system of ventilation is inferior to a Manujet in terms of robustness and calibration throughout its range of pressures and flows, but seems appropriate for emergency use in the absence of a purpose-made jet ventilator.
-
Letter Multicenter Study
Hypertonic saline after traumatic brain injury in UK neuro-critical care practice.