Anaesthesia
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An 8-week survey was conducted to determine whether the introduction of low-flow anaesthesia (a fresh gas flow of 4 litres/minute or less) into routine use would be acceptable to members of a representative anaesthetic department and if the consequent reduction in use of volatile anaesthetics would result in financial savings. The hourly consumption of the volatile agents was measured during anaesthesia conducted using either conventional or low fresh gas flows. Anaesthetists' acceptance of low-flow anaesthesia was assessed using a questionnaire. ⋯ A 54.7% reduction in the consumption of isoflurane and a 55.9% reduction in that of enflurane was found. Of the 28 anaesthetists at the hospital, 21 would use low-flow anaesthesia routinely. The routine use of low-flow anaesthesia would therefore be acceptable and could result in annual savings of 26,870 pounds at Northwick Park Hospital.
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Two pre-operative tests for the prediction of difficult intubation are assessed. A modified Mallampati test and a measurement of thyromental distance were performed at the pre-operative visit of 244 patients whose tracheas were subsequently intubated under general anaesthesia. Patients in whom the posterior pharyngeal wall could not be visualised below the soft palate, who also had a distance of less than 7 cm between the prominence of the thyroid cartilage and the bony point of the chin proved significantly more likely to present difficulty with intubation. The performance of these two simple tests on all patients before operation should allow the majority of cases of difficult intubation to be anticipated.