Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Mar 1981
Foreign bodies in the respiratory tract. A review of forty-one cases.
The nature of inhaled foreign bodies in the respiratory tract and problems in their removal are reviewed with reference to experience in a series of 41 cases, 36 of them in children under 4 years old. Bronchoscopic removal under general anaesthesia is preferred to inhalational therapy and postural drainage.
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Herniation of the hindbrain occurs when the lowest parts of the cerebellum and sometimes part of the medulla are moved downwards through the foramen magnum, a pressure difference acting across the foramen magnum moulding the tissues into a plug. It is suggested that the clinical course in both adults and babies with spina bifida may be explained by the hindbrain hernia acting as a valve. The term 'Chiari Type I deformity' is commonly used for an abnormality in which the tonsils and lowermost parts of the cerebellar hemispheres are prolapsed through a normal foramen magnum. ⋯ Measurement of pressure in the cerebrospinal fluid above and below the foramen magnum shows that intermittent pressure difference is commonly present at times of neurological deterioration. Surgical decompression of the hernia in adults allows correction of the valvular effect, which may be monitored by pressure measurements. In babies the associated hydrocephalus is usually so gross that it requires separate treatment, but pressure monitoring may be of value in assessing the state of the disease.
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Eighty-one central venous catheter placements have been carried out with a serious-complication rate of 3.7%. Major long-term complications occurred in 5 patients. Malplacement of the catheter was more common when the infraclavicular subclavian route was used. Inadvertent removal occurred on 10 occasions and a new design of catheter hub is expected to eliminate this problem.
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The functions of an outpatient anaesthetic clinic are discussed in relation to the first 100 patients who attended. Preoperative assessment excluded 11 patients who would have been refused anaesthesia for elective operations without further treatment. ⋯ The clinic also played an important role with regard to advice and reassurance of the patient from an experienced anaesthetist, organising suitable admission dates, and detecting anaesthetic and surgical hazards, especially dental caries and obesity, which could be corrected before operation. Two patients developed postoperative complications which could not have been foreseen.
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Ann R Coll Surg Engl · Mar 1980
Frequency of atopy, allergy, and previous general anaesthesia in surgical specialties.
This paper reports part of a large survey of atopy, allergy, and previous anaesthesia in 10 000 preanaesthetic patients. The occurrence of these risk factors in the various surgical specialties has been assessed. Obstetric patients have a significantly higher frequency of atopy and allergy than the total female population studied. Among males cardiothoracic patients are the only group to have a significantly higher frequency of atopy and allergy than the overall figure for their sex.