Anaesthesia
-
Case Reports
Apparent massive tongue swelling. A complication of orotracheal intubation on the Intensive Care Unit.
The trachea of an 81-year-old woman was intubated with an orotracheal tube for emergency abdominal surgery and the tube was left in place for postoperative management on the Intensive Care Unit. After 36 h, she developed apparent massive tongue swelling. On closer examination, a normal sized tongue was found to be displayed by oedema of the floor of the mouth and submandibular space, secondary to purulent sialadenitis from right submandibular duct obstruction by the tracheal tube.
-
This paper describes the design and initial testing of the ACCESS (Anaesthetic Computer Controlled Emergency Situation Simulator) system, which has been designed to simulate anaesthetic emergencies with the aim of providing training for junior doctors. The simulations require little or no capital expenditure with minimal use of time by staff or trainees. ⋯ During 64 scenarios, five trainees caused two 'deaths' and solved the problems in a median time of 2.5 min, while an experienced group of anaesthetists caused one 'death' and took 1.8 min. The simulation was rated by the pupils as easy to use, realistic and a valuable educational tool.
-
Randomized Controlled Trial Clinical Trial
Effects of the cervical collar on cerebrospinal fluid pressure.
We investigated the hypothesis that cervical collars might compress the internal jugular veins and raise intracranial pressure in head-injured patients. In a randomised, single-blind, crossover study of nine patients scheduled for elective spinal anaesthesia the cerebrospinal fluid pressure in the lumbar subarachnoid space was measured with and without a 'Stifneck' cervical collar applied. There was a significant elevation of cerebrospinal fluid pressure in seven of the patients studied when the cervical collar was applied (p < 0.01). This preliminary study raises the possibility that immobilisation of the cervical spine with the 'Stifneck' cervical collar may, by raising the intracranial pressure, contribute to secondary neurological injury in head-injured patients in whom intracranial compliance is already reduced.
-
Randomized Controlled Trial Clinical Trial
Infra-orbital nerve block for relief of postoperative pain following cleft lip surgery in infants.
The study was conducted on 20 infants scheduled for cleft lip repair surgery. Ten were randomly allocated to receive bilateral infra-orbital local anaesthetic nerve blocks at the conclusion of surgery with the other 10 receiving bilateral 'sham' blocks as controls. Postoperative pain relief was assessed using a pain assessment scoring system and by monitoring arterial blood pressure, heart rate and respiratory rate. ⋯ There were no significant statistical or clinical differences in the physiological measurements between the two groups. The infants receiving the block required less analgesia in the postoperative period. The results suggest that infra-orbital nerve block is a simple and effective means of achieving postoperative analgesia after cleft lip repair surgery in infants.