Anaesthesia
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A new prototype laryngeal mask airway is described which incorporates a second mask to isolate the upper oesophagus and a second dorsal cuff to increase the seal against the glottis. We have made a within-patient comparison of seal pressures between the prototype and standard laryngeal mask airway in 20 patients, and determined if the prototype facilitates functional isolation of the glottis and upper oesophagus. ⋯ Ease of insertion and incidence of pharyngeal morbidity appeared similar to the standard laryngeal mask, but were not formally tested. The prototype laryngeal mask airway exhibits potentially useful new features which justify further evaluation and development.
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Review Case Reports
Massive lingual swelling following palatoplasty. An unusual cause of upper airway obstruction.
We report a case of upper airway obstruction as a result of delayed massive lingual swelling following routine cleft palate repair in an otherwise healthy 12-month-old girl. We believe that ischaemia and venous congestion were the causes of macroglossia, after prolonged use of the Digman Dott tongue retractor. In any difficult and lengthy repair, we recommend the prophylactic insertion of a nasopharyngeal airway under direct vision by the surgeons after surgery to prevent potential upper airway obstruction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography.
We evaluated possible differential effects of vecuronium on the thumb and great toe using two types of neuromuscular transmission monitor. Train-of-four stimuli were simultaneously applied to the ulnar nerve and tibial nerves using cutaneous electrodes. The responses were quantified with accelographs (thumb and left great toe) and an electromyograph (right great toe). ⋯ The differences between the thumb and great toe were statistically significant during both types of anaesthesia when measured with the accelograph (p < 0.01). The time from completion of maximal block to 25% recovery of twitch height in the thumb was significantly longer than that of the great toe as measured by accelography during both types of anaesthesia (p < 0.05). In contrast, there were no statistically significant differences between time to maximum block and 25% recovery of twitch height of the thumb as measured by accelography compared to the values measured for the great toe using electromyography during either anaesthetic technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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We report the management of anaesthesia for Caesarean section in a woman with severe extensive tracheal stenosis. Management was initially with spinal anaesthesia, but general anaesthesia became necessary as a result of profuse intra-operative bleeding. We describe the use of the Hayek oscillator cuirass ventilator to allow instrumentation of the larynx whilst maintaining respiratory support, and for weaning from mechanical ventilation.