Anaesthesia
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Comparative Study
A comparison of different methods of lubrication of glass syringes used to identify the epidural space.
Measurement of loss of resistance in glass syringes is a method widely used to locate the epidural space in epidural anaesthesia. Static and dynamic forces were measured under four experimental conditions in new glass syringes: unpolished, dry; polished, dry; unpolished, saline lubricated; and polished, saline lubricated. ⋯ These values were significantly greater than for polished dry syringes where the values were 5.27 (2.1) g and 4.38 (0.94) g, respectively. The results show that the least amount of resistance to plunger movement is obtained by dry polishing glass syringes.
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A standard Boyle International anaesthetic machine was modified to allow operation in either a continuous flow or a drawover mode. This was achieved by fitting a valve in the backbar which allows entrainment of air under drawover conditions. The details of the valve and modification are discussed and an evaluation of the machine in a Central African hospital is presented.
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Case Reports
A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah's Witness.
Blood volume was maintained by an infusion of hydroxyethyl starch 2000 ml (Hespan: HES) during and for the first 28 hours after a major orthopaedic operation in a 13-year-old girl who was a Jehovah's Witness. This was responsible for a generalised clinical haemorrhagic state, an acquired coagulopathy associated with a shortened thrombin, prolonged prothrombin and activated partial thromboplastin times, and an acquired von Willebrand syndrome. The coagulation, after cessation of the infusion of HES, did not become normal until approximately 72 hours later.
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The incidence of tracheal tube cuff rupture was noted in 30 polyvinyl chloride tracheal tubes lubricated with three different solutions. All cuffs moistened with water were intact after 2 hours of cuff inflation whereas two of 10 lubricated with 4% lignocaine solution had burst. Both of these had leaked at the site of cuff attachment to the tube. ⋯ Four of the five had developed pinholes in the cuffs themselves. The remaining 50% of this group showed marked distortion and thinning of their intact cuff walls. The implications of these findings are discussed in view of the widespread use of PVC tracheal tubes.