Anaesthesia
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A simple test rig was developed to assess the force applied during the application of cricoid pressure. Anaesthetists and paramedical personnel familiar with Sellick's manoeuvre were tested yielding results which indicate an unacceptably wide variation in performance in each group. ⋯ In addition a survey was undertaken of trained anaesthetic staff to identify the current status of the manoeuvre. Of those sampled 78% routinely employed Sellick's manoeuvre and over 70% had experienced a problem with its application which exposed the patient to the risk of regurgitation.
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A study of cricoid pressure was undertaken to relate the applied cricoid force with the resulting intraluminal cricopharyngeal (or oesophageal) pressure. The results indicate that whilst there was a wide range in normal adults a cricoid force of 44 N was judged to be effective in protecting the majority of adult patients from regurgitation.
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A new simple anaesthetic breathing system is described which has been designed to incorporate into a single system advantages of Mapleson A, D and E type systems. Coaxial and non-coaxial versions are available. The system can be used for adults, children or neonates and allows both spontaneous or controlled ventilation with low fresh gas flows at all times. ⋯ The system is safe, simple in design and operation, and is easily sterilized. Further it offers low resistance to expiration and facilitates scavenging at all times which, with low anaesthetic gas flows, permits complete theatre pollution control. Its potential application in academic and rural environments and major advantages over the circle absorber system are discussed.