Anaesthesia
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Clinical Trial Controlled Clinical Trial
Correct positioning of the epiglottis for application of the Brain laryngeal mask airway.
Positioning of the epiglottis when the Brain laryngeal mask airway is in place was studied in 20 adult patients, using a new technique of insertion. The laryngeal mask was inserted when the anterior displacement of the mandible extended the epiglottis, thereby the providing an excellent airway in all patients. In 10 out of these 20 patients, the conventional technique of insertion revealed an incomplete extension of the epiglottis, and inadequate opening of the laryngeal inlet. It was concluded that the anterior displacement of the mandible during insertion of the laryngeal mask enhances the opening of the larynx, the result being an excellent airway.
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Case Reports
Anaesthesia for caesarean section in a patient with Klippel-Feil syndrome. The use of a microspinal catheter.
A 34-year-old woman with severe kyphoscoliosis, an immobile cervical spine, and short stature due to the Klippel-Feil syndrome presented for elective Caesarean section. She expressed a strong desire to remain awake during the procedure. We chose a technique using a spinal microcatheter to provide spinal anaesthesia on the basis that incremental control of the dose of bupivacaine would reduce the risk of 'high' block. ⋯ A total of 6.25 mg heavy bupivacaine, 7.5 mg plain bupivacaine, and 10 micrograms fentanyl were administered over 20 min. This provided anaesthesia up to T5 without significant effects on respiratory or cardiovascular function. The patient was successfully delivered of a healthy boy.
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An evaluation of the Universal PAC and Oxford Miniature Vaporizers for paediatric field anaesthesia.
A laboratory study has demonstrated that the Universal PAC and Oxford Miniature Vaporizers can be used for paediatric anaesthesia in drawover mode at varying ambient temperatures. Changes in tidal volume have minimal effect on the delivered concentration of halothane from either vaporizer but varying ambient temperature significantly affects the output of the Oxford Miniature Vaporizer. The Oxford performs well in continuous flow mode, which is of particular use for T-piece anaesthesia, whereas the Universal PAC does not perform adequately in this way.
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Two hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classification proposed by Cormack and Lehane. The overall prevalence of difficulty (grades 3 and 4) was 20%. ⋯ The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator of poor cranio-cervical extension. Difficulty was rare in patients with class A mandibular protrusion, and invariable in patients with class C protrusion.