Anaesthesia
-
An ambient pressure oxygen reservoir bag apparatus for connecting to the nonventilated lung as soon as single-lung ventilation is initiated is described. The theoretical benefits are the facilitation of collapse of the lung on the side of surgery and a reduced likelihood of arterial desaturation. Although these main benefits are yet to be proven, the authors believe that the weight of theoretical argument and practical observation serves to justify the use of the apparatus while the outcome of suitably designed clinical trials is awaited. It can be used for all one-lung anaesthetics and is especially recommended for thoracoscopic surgery, where temporary re-expansion of the nonventilated lung is either counter-productive or contraindicated, and where there is a possibility that lung collapse may be delayed.
-
Case Reports
The use of epidural ropivacaine in high doses for the management of pain from invasive carcinoma of the cervix.
A case is presented of a young woman with advanced cervical cancer invading the rectum and sacral nerves giving rise to an intractable pain state. The management of her symptoms using a domicillary infusion of diamorphine with high doses of ropivacaine is described. It is believed that this is the first presentation of ropivacaine being used in daily doses approaching 2 g, and the associated problems are discussed.