Anaesthesia
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Biography Historical Article
The Trilite inhaler. An historical review and performance assessment.
The Trilite inhaler was developed for use in World War II. Its efficient performance is confirmed and a brief biography of its inventor is also given.
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A new needle, 120 mm long and 26 gauge in diameter, has been introduced for subarachnoid anaesthesia. The resistance to flow through the needle was measured using a pressure monitor infusion pump and compared with the resistance to flow through a 90-mm 26-gauge needle; there was a threefold increase in resistance in the 120-mm needle compared to the 90-mm needle, which could not be explained by the difference in length alone and must reflect a decrease in the internal diameter of the long needle. This results in difficulty in identifying the subarachnoid space by backflow of cerebrospinal fluid.
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The laryngeal mask airway was used in 200 children during a variety of surgical procedures. Some problem with the use of the device was encountered in 47 cases (23%), but in only five cases (2.5%) were the problems serious enough to warrant abandonment of its use. ⋯ The mask was used in 16 children with known airway problems. It is concluded that the size 2 laryngeal mask airway can be successfully used within the weight range 6-30 kg.
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Randomized Controlled Trial Clinical Trial
Successful difficult intubation. Tracheal tube placement over a gum-elastic bougie.
A randomised study was carried out to assess the effect of tracheal tube rotation on the passage of a tube over a gum-elastic bougie into the trachea in 100 patients. The effect of the presence or absence of a laryngoscope on successful tube placement was also assessed. A grade 3 difficult intubation was simulated in patients with a laryngoscope. ⋯ The unsuccessful first-time intubations with a 0 degree orientation were frequently converted to successful intubations with the -90 degrees position at a second attempt. The presence of a laryngoscope in the mouth while rail-roading a tube over the bougie also made a significant difference to the rate of successful first-time intubations. The most successful method was to leave the laryngoscope in the mouth and rotate the tube to -90 degrees.
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Comparative Study Clinical Trial
An evaluation of a 30-gauge needle for spinal anaesthesia for caesarean section.
A 30-gauge spinal needle was evaluated for Caesarean section, using a combined epidural/spinal technique, in 50 mothers. Spinal anaesthesia failed in six mothers and was inadequate in another six. General anaesthesia was required on one occasion. A 25% overall failure rate suggests that a 30-gauge needle is not a practical proposition for routine clinical practice.