Anaesthesia
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The tracheas of 20 ASA grade 1 and 2 patients were each consecutively intubated with an oral and nasal cuffed tracheal tube. Measurements of tube movement, as the position of the head and neck altered, were made with a fibreoptic bronchoscope. Both oral and nasal tubes moved an average distance of 15 mm towards the carina with head and neck flexion and 8.5 mm away with head and neck extension. ⋯ Optimal placement of tracheal tubes can be aided with a single guide mark placed 3 cm proximal to the cuff and 8 cm proximal to the distal end, which may reduce complications arising from this movement. This is a better method in women than inserting a pre-determined length of tracheal tube measured from the lips or nares. However, current guide marks vary in their position relative to the cuff and tip of the tube.
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Case Reports
Tracheal occlusion in the prone position in an intubated patient with Duchenne muscular dystrophy.
A 15-year-old boy with Duchenne muscular dystrophy developed complete airway obstruction under general anaesthesia when positioned prone for spinal surgery. Tracheobronchial compression against vertebral bodies facilitated by a shortened sternovertebral distance due to thoracic lordoscoliosis is suggested as the cause.
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We assessed the basic and advanced cardiopulmonary resuscitation skills of 30 trainee anaesthetists in a simulated exercise. Only one person performed basic cardiopulmonary resuscitation as outlined in the 1992 European Resuscitation Council guidelines. ⋯ Neither the seniority of the anaesthetists nor their postgraduate qualifications correlated with their performance level. We conclude that all trainee anaesthetists need to undergo regular training and assessment of their resuscitation skills.
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A technique for the use of the Olympus LF-P as an aid to tracheal intubation, via the oral route, in 40 anaesthetised, spontaneously breathing children is described. The technique was completely successful in 30 (75%) of the children. ⋯ The two children who developed laryngospasm and three of the children in whom the fibrescope flipped out of the trachea required conventional laryngoscopy and tracheal intubation. Whilst this technique allowed for training in the use of the LF-P in paediatric anaesthesia there were a number of complications.