Anaesthesia
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Angioedema of the face and neck is an uncommon but potentially life-threatening complication of angiotensin-converting enzyme (ACE) inhibitor therapy. This condition is of particular concern to the anaesthetist as it can rapidly progress to upper airway obstruction. We describe the presentation and management of five cases of ACE inhibitor related angioedema, all of which were associated with significant upper airway obstruction.
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Viral gastroenteritis is usually a mild, self-limiting illness. We report a case of a previously well 74-year-old woman who suffered a grave complication of this common condition, and caused a significant outbreak of illness amongst staff involved in her care. This case highlights the risks of Hospital Acquired Infection and raises important infection control issues. It illustrates the hazards associated with exposure to potentially infectious secretions and presents a clear message to medical and nursing staff involved in the care of the acute surgical emergency.
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Case Reports
Local anaesthesia and sedation for rigid bronchoscopy for emergency relief of central airway obstruction.
We report three experiences that illustrate the use of local anaesthesia for rigid bronchoscopy. All patients were acute emergencies, with life-threatening central airway problems. Instruments were inserted after the airway was anaesthetised using a technique that owes much to mid 20th Century methods for inserting endobronchial blockers. ⋯ Concomitant sedation reduced the unpleasantness of the experience in a way that in the past could only be dealt with by careful attention to the humanitarian elements of detail. Problems of oxygenation were ameliorated by periodically superimposing intermittent jetting with a Sanders injector fed from the oxygen pipeline. A need for developing and refining topical and other local anaesthetic techniques for rigid bronchoscopy is anticipated with the expansion of services for tracheo-bronchial stenting and lasering.
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Aeromedical transport of mechanically ventilated critically ill patients is now a frequent occurrence. However, the performance of the air filled tracheal tube cuff at altitude has not been studied in vivo. ⋯ With air providing the seal in the cuff the mean rise in cuff pressure was 23 cmH2O, which took the pressures above the critical perfusion pressure of the tracheal mucosa. This could lead to tracheal injury.
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Breathing system filters can be used to humidify gases delivered to patients. Performance can be determined by measuring the net moisture loss (the difference between expired and inspired levels of humidity) from a patient model. ⋯ The net moisture loss decreased as the humidity in the breathing system increased and was less for the lower tidal volume. Adequate levels of humidity (>/= 20 g.m-3) will be delivered to patients by most filters provided they are used in conjunction with circle breathing systems and low fresh gas flows.