Anaesthesia
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The management of a patient who required positive pressure ventilation following pharyngolaryngo-oesophagectomy during which tracheal injury was sustained is described. Ventilation with a tracheal tube resulted in a massive pneumoperitoneum. Bilateral bronchial intubation was employed with success.
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Intravenous suxamethonium, in a dose as small as 0.1 mg.kg-1, has been found to be reliable in the treatment of laryngeal spasm. Three episodes of vocal cord spasm observed during direct laryngoscopy were relieved by this dose of suxamethonium.
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Sixty adult patients following general surgical operation were treated with patient-controlled analgesia using morphine. Patients were allocated into three groups to receive: no background infusion, a 1 mg.h-1 or a 2 mg.h-1 background infusion. The other controls on the patient-controlled analgesia machine were set to allow a maximum dose of morphine of 6 mg.h-1 to each group. ⋯ Patients who received a background infusion of 2 mg.h-1 had an increased incidence of nausea (p < 0.05). A background infusion of 1 mg.h-1, with a 1 mg bolus dose and a 12 min lockout interval provided acceptable pain relief without excessive nausea. In all three groups the ratio of analgesic requests to successful deliveries correlated with the degree of pain reported by visual analogue score (p = 0.0001).
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Twenty patients undergoing elective procedures on the larynx and pharynx were anaesthetised using a propofol infusion and a bolus of vecuronium. High frequency jet ventilation was employed via a 7 French gauge catheter, with a second catheter being used to measure expired carbon dioxide levels. The Bullard laryngoscope was compared with the Macintosh instrument both for visualising the larynx and subsequently inserting a catheter. ⋯ Using the Bullard laryngoscope, intubation was possible in all 20 patients, in a mean time of 22 (6.8) s. Using the Macintosh laryngoscope only 16 patients could be intubated and this took significantly longer at 34 (18.3) s (p < 0.05). The Bullard laryngoscope and high frequency jet ventilation offer a reliable method of intubating and anaesthetising patients with upper airways pathology and further benefits may accrue in the recovery period.