Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2024
A weighing method for measuring nitrous oxide leakage from hospital manifold-pipeline networks.
Nitrous oxide is a potent greenhouse gas and ozone-depleting agent with a long atmospheric lifetime. Several previous reports indicate that over half of supplied nitrous oxide is wasted from leaking manifold-pipeline systems infrastructure prior to patient use, and that remediating leaks can have significant environmental benefits. We describe an accurate, simple and cost-effective cylinder weighing method to quantify nitrous oxide leak from the manifold-pipeline network at our tertiary non-obstetric facility. ⋯ This was only 16.5% of actual cylinder depletion (11,686 l; 21.88 kg), indicating that 83.5% (9754 l; 18.26 kg) of nitrous oxide had leaked to the atmosphere (376 ml/minute; 22.6 l/hour; 542 l/day). The fraction of nitrous oxide wasted was consistent with a retrospective analysis of the previous 2-year period at the site that compared purchasing records with estimated clinical use. If maintained over a year, the leak would be equivalent to 101 tonnes of carbon dioxide per annum.
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Anaesth Intensive Care · Jan 2024
ReviewAirway management of lingual tonsillar hypertrophy: A narrative review.
Lingual tonsillar hypertrophy is rarely identified on routine airway assessment but may cause difficulties in airway management. We conducted a narrative review of case reports of lingual tonsillar hypertrophy to examine associated patient factors, success rates of airway management techniques and complications. We searched the literature for anaesthetic management of cases with lingual tonsillar hypertrophy. ⋯ Our findings show that severe cases of lingual hypertrophy may cause an unanticipated difficult airway and serious complications, including hypoxic brain damage and death. A robust airway strategy is required which includes limiting the number of attempts at laryngoscopy, and early priming and performance of emergency front of neck access if required. In patients with known severe lingual tonsillar hypertrophy, awake intubation should be considered.