Anaesthesia
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There are no published comprehensive surveys of paediatric recovery room experience and the incidence of complications. A prospective survey was made of 16,700 consecutive admissions to the recovery room at the Royal Manchester Children's Hospital during the years 1985-1988. The incidence of respiratory complications was low, with laryngospasm 0.85%. ⋯ The incidence of vomiting in the recovery room was also lower than in comparable adult studies. Certain aspects of recovery room practice changed during the 4 years of the study; these included routine oxygen administration, parents in the recovery room, and our approach to postoperative analgesia. The implications of these changes are discussed.
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Pressure-sensitive ventilator disconnexion alarms do not always alarm during disconnexion of a discharging compliance ventilator such as Manley Blease, unless accurately adjusted. High flows during disconnexion result in significant pressure generation caused by outflow resistance of catheter mounts, heat and moisture exchangers, capnometer cuvettes, and angled connectors; this may lead to alarm failure because of incorrectly adjusted pressure alarm limits. The exact position of the disconnexion is critical and if the alarm's pressure sensor is placed in either the inspiratory or expiratory limb of the ventilator it makes no difference to its correct function. ⋯ Those with 15-mm male connectors generate the highest pressures on disconnexion (1.1 kPa). It is suggested that the low pressure alarm limit is set only marginally below the peak inspiratory pressure, and that it is readjusted for every patient and after every change in ventilation. Most importantly, the alarm should be shown to be functional by a trial disconnexion at the tracheal tube.
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The tracheas of 420 adult patients were intubated using the tip of a lighted stylet placed inside the lumen of the tracheal tube, just proximal to the tube cuff. The maximum point of transillumination was visible just distal to the cricoid cartilage, with proper cuff positioning. The lighted stylet was also introduced into the oesophagus to see whether transoesophageal illumination could be demonstrated. ⋯ Transoesophageal illumination could not be demonstrated in any patient. The mean distance between the tip of the tracheal tube and the carina varied between 3.7 and 4 cm. Transtracheal illumination is a simple, effective and reliable method that can be used during intubation for the recognition of optimal tube placement.
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Editorial Biography Historical Article
Professor Emeritus Sir Robert Reynolds Macintosh 17 October 1897-28 August 1989.