Anaesthesia
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Clinical Trial
Safety and efficacy of the laryngeal mask airway. A prospective survey of 1400 children.
A survey of laryngeal mask airway usage in 1400 infants and children by ten trainee anaesthetists was undertaken to provide information about insertion and complication rates using the standard insertion technique and a limited range of standardised anaesthetic techniques. Placement was successful in 90% (1258/1400) at the first attempt, 8% (112/1400) at the second attempt and 2% (29/1400) required an alternative technique of insertion. One patient vomited during insertion and the procedure was abandoned, but aspiration did not occur. ⋯ There was a significant decrease in problems with increasing experience (p < 0.001). There was no major morbidity associated with use of the device. We conclude that the laryngeal mask provides a safe and effective form of airway management for infants and children in the hands of supervised anaesthesia trainees both for spontaneous and controlled ventilation using either isoflurane or total intravenous anaesthesia.
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A 13-year-old boy presenting for correction of bat ears was anaesthetised with thiopentone and suxamethonium, the administration of which was followed by jaw spasm, poor peripheral perfusion (without cyanosis) and marked tachycardia. The procedure was abandoned, dantrolene and Ringer lactate IL were given intravenously and the patient regained consciousness 1 h later. ⋯ Despite a peak serum myoglobin of 58.000 micrograms.l-1 and peak urinary level of 446,000 micrograms.l-1, no renal impairment occurred. Subsequent testing for susceptibility to malignant hyperthermia proved positive for the patient and four other members of the family.
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Having used the Boyle's bottle vaporizer apparatus out of necessity in a developing country, the concentration of agent that had been administered was investigated retrospectively. Three anaesthetic agents, halothane, isoflurane and enflurane, were measured at different temperatures, using a Boyle's anaesthetic machine and a Boyle's bottle in circuit with a Magill breathing system connected to a Rascal II Agent Monitor. Bubbling a fresh gas flow of 5 l.min-1 through the anaesthetic liquids generated concentrations in excess of 12%. ⋯ The Boyle's bottle vaporizer may be used with modern anaesthetic agents such as halothane, isoflurane and enflurane. However, the limitations of and variations between vaporizers should be borne in mind. An agent monitor employed at the patient end of the circuit would be an important safety feature.
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Case Reports
Management of Caesarean delivery in the presence of a large pelvic vascular malformation.
Caesarean section is associated with significant cardiovascular disturbances. We present a patient known to have a large pelvic arteriovenous malformation who underwent elective Caesarean section. To assist in the monitoring and management of the anticipated haemodynamic changes a flow directed pulmonary artery catheter with the capacity to allow continuous cardiac output measurement was used.
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We undertook a postal survey to determine the views of all consultant anaesthetists within the North West (Mersey) Regional Health Authority on the Calman proposals for a consultant-based service; replies were received from 110 (84%). Fifty (45%) indicated that they would not resume emergency residential duties, 32 (29%) indicated that they would withdraw from the emergency duty rota, 12 (11%) said they would withdraw/retire from the NHS and 27 (25%) would change hospital under these circumstances. ⋯ When questioned about the impact on anaesthetic services, 67 (61%) felt the proposals would be detrimental whilst 23 (21%) felt there would be beneficial effects. Most consultants remain antagonistic toward the Calman proposals, with a reluctance to return to residential duties.