Anaesthesia
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Implantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. ⋯ In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.
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A technique for the use of the Olympus LF-P as an aid to tracheal intubation, via the oral route, in 40 anaesthetised, spontaneously breathing children is described. The technique was completely successful in 30 (75%) of the children. ⋯ The two children who developed laryngospasm and three of the children in whom the fibrescope flipped out of the trachea required conventional laryngoscopy and tracheal intubation. Whilst this technique allowed for training in the use of the LF-P in paediatric anaesthesia there were a number of complications.
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Comparative Study
Laryngeal mask airway insertion using cricoid pressure and manual in-line neck stabilisation.
Forty patients were studied to assess the ease of insertion of the laryngeal mask in the simultaneous presence of cricoid pressure and manual in-line stabilisation of the neck. This was compared with the normal technique of laryngeal mask insertion in the same patients. Fibreoptic views obtained through the laryngeal mask were documented on each occasion. ⋯ When cricoid pressure and neck stabilisation were applied, vocal cord visualisation through the laryngeal mask with a fibreoptic bronchoscope was only possible in 15 patients. With the head in the normal position the vocal cords were seen in 33 patients. The implications of these results are discussed with respect to the role of the laryngeal mask in the multiply injured patient.
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Case Reports
Tracheal occlusion in the prone position in an intubated patient with Duchenne muscular dystrophy.
A 15-year-old boy with Duchenne muscular dystrophy developed complete airway obstruction under general anaesthesia when positioned prone for spinal surgery. Tracheobronchial compression against vertebral bodies facilitated by a shortened sternovertebral distance due to thoracic lordoscoliosis is suggested as the cause.
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We assessed the basic and advanced cardiopulmonary resuscitation skills of 30 trainee anaesthetists in a simulated exercise. Only one person performed basic cardiopulmonary resuscitation as outlined in the 1992 European Resuscitation Council guidelines. ⋯ Neither the seniority of the anaesthetists nor their postgraduate qualifications correlated with their performance level. We conclude that all trainee anaesthetists need to undergo regular training and assessment of their resuscitation skills.