Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1987
The position of the larynx in children and its relationship to the ease of intubation.
Lateral radiographs of the upper airway of children aged from birth to puberty were used to determine the changes in position, with growth, of the tip of the epiglottis, the hyoid, the glottis, and the inferior margin of the cricoid cartilage. There is a marked descent of these structures relative to the cervical spine during the first two years of life. ⋯ In adults the best view is obtained with the atlanto-occipital joint fully extended and the head resting on a low pillow. Anatomical explanations for these observations are presented.
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A survey was conducted to investigate the attitudes of anaesthetists and nurses to anaesthetic pollution. In order that the results could be viewed in context, attitudes to other possible occupational hazards, including radiation exposure and work-related stress, were also investigated. Four hundred (66%) completed questionnaires were returned. ⋯ Levels of concern were similar for radiation exposure; however, both occupational groups expressed higher levels of concern about work-related stress. Seventeen (21%) anaesthetists and 46 (14%) nurses reported having suffered adverse health effects which they thought were due to anaesthetic pollution. The most frequent complaints were headache and fatigue.
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Anaesth Intensive Care · Nov 1987
Comparative Study Clinical Trial Controlled Clinical TrialComparison of propofol and antagonised midazolam anaesthesia for day-case surgery.
A technique of midazolam/fentanyl/isoflurane/nitrous oxide anaesthesia, in which the benzodiazepine was antagonised by the specific antagonist, flumazenil, was compared with propofol/fentanyl/nitrous oxide anaesthesia for minor outpatient urological surgery. No significant difference was found in the overall ease of anaesthesia; however, using subjective (linear analogue sedation scales) and objective (letter deletion and simple reflex time) tests, recovery was found to be significantly slower for the antagonised midazolam group. ⋯ The midazolam group displayed the greatest degree of residual sedation at the 4-hour time of discharge and on arrival home a significantly larger number of patients in the midazolam group slept for a period. It is likely that the dose of flumazenil chosen (1 mg) was inadequate to completely antagonise the dose of midazolam (mean 17 mg) for the full duration of recovery.