Anaesthesia
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The American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by anaesthetists. A postal questionnaire was sent to 113 anaesthetists of varying experience working in the Northern Region of England. They were asked to allot ASA grades to 10 hypothetical patients. ⋯ In no case was there complete agreement on ASA grade, and in only one case were responses restricted to two of the five possible grades. In one case there was a significant difference in answers between anaesthetists with the FRCA (or equivalent) qualification, and those without. So much variation was observed between individual anaesthetist's assessments when describing common clinical problems that the ASA grade alone cannot be considered to satisfactorily describe the physical status of a patient.
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A patient underwent oesophageal dilatation for invasive secondary carcinoma. During the course of the procedure, ventilation of the patient's lungs became impossible due to total tracheal obstruction. A rigid bronchoscopy was performed and the cause was found to be fragments of tumour that had broken off and were behaving like a ball-valve in the trachea and right main bronchus.
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The use of unsheathed non-insulated needles and a nerve stimulator as an aid to peripheral nerve blockade in children has received little attention in the literature. In order to assess the value of such a technique, a study was performed in children presenting for lower limb surgery with no contraindication to femoral and/or sciatic nerve block. Four hundred and eleven children, mean age 4.25 (SD 3.8) years and mean weight 16.8 (SD 9.4) kg, received a total of 883 peripheral nerve blocks: 419 femoral nerve blocks and 464 sciatic nerve blocks. ⋯ The current required to stimulate the more superficial femoral nerve ranged from 0.5-1.0 mA whilst for the deeper sciatic nerve ranged from 1.2-2.0 mA. Staff in training, with little or no experience of the technique, successfully performed 223 nerve blocks in 114 patients under the author's guidance. The overall success rate was 98%, the failures occurring early in the series.
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Biography Historical Article Classical Article
An anaesthetic inhaler with automatic thermo-compensation. 1956.