Anaesthesia
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The use of ketamine anaesthesia is described for the transport from home to hospital of patients in severe pain secondary to malignant disease. The technique is simple and highly effective and introduces a new role for anaesthetists and pain relief specialists.
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A cuffed nasopharyngeal airway was used in five cases of difficult intubation, initially to maintain anaesthesia, and subsequently to act as a landmark for the passage of a fibreoptic laryngoscope loaded with a tracheal tube. In all cases, airway patency was well preserved with the device and there were no significant problems with its use. The notion of a 'dedicated airway' for difficult intubation cases is developed. A trouble-free airway will permit time to consider solutions for difficult cases and time for the novice to learn fibreoptic laryngoscopy technique.
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We asked 20 anaesthetists and seven operating department assistants to check three anaesthetic machines 'doctored' to contain errors of varying seriousness, and recorded their performances. Two weeks later we asked the same group to repeat the test. On the second occasion they followed a visual aid and filled in a questionnaire about the test. ⋯ The visual aid was most useful at increasing the detection rate of machine leaks. Of the participants, 60% considered that the visual aid was helpful and 74% thought that such an aid should be available in our theatre complex. Sixty-six percent of those questioned felt that a formal check list would be of use.