British journal of anaesthesia
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The successful management of a 29-yr-old patient with tracheal separation between rings one and two after attempted hanging is described. Increasing difficulty with ventilation via a tracheal tube and surgical emphysema indicated the need for a tracheostomy. The diagnosis was made during the tracheostomy procedure when it was observed that the tracheal tube was protruding through the incomplete transection of the trachea such that Murphy's eye was aligned with the lower tracheal stump. ⋯ The signs and symptoms of laryngotracheal separation after blunt trauma are described. A review of the airway management has been made as it requires combined anaesthetic and surgical expertise. Injuries to the trachea may have severe, life-threatening consequences and early diagnosis and management reduce morbidity and mortality.
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The efficacy of preoperative fasting is reduced in the presence of any factor which delays gastric emptying. We examined the association between anxiety and gastric emptying in adult patients undergoing elective surgery. Immediately before operation, 21 patients completed both a Spielberger state trait inventory (used to quantify current anxiety state (STAIs) and anxiety predisposition (STAIt)), and the Amsterdam preoperative anxiety and information scale (used to quantify anxiety and need for information). ⋯ Patients were more anxious before than after operation (STAIs = mean 35.4 (SD 10.9) and 25 (4.1), respectively; P = 0.0004). Neither anxiety state (P = 0.40) nor measures of anxiety relative to anxiety predisposition (P = 0.86) influenced gastric emptying (as measured by area under the paracetamol absorption-time curve). This contrasts with previous findings that anxiety in patients with low anxiety predisposition scores delays gastric emptying.
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Percutaneous dilatation tracheostomy has become a common procedure for bedside insertion of tracheostomy tubes in the intensive care unit. Management of the airway during the procedure using the laryngeal mask airway (LMA) and other methods has been described. ⋯ These include the use of both the fibreoptic bronchoscope and tracheal tube if necessary. We report the results of a pilot study of 10 patients that illustrates these advantages.
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Comparative Study
Critical haemoglobin concentration in anaesthetized dogs: comparison of two plasma substitutes.
We have explored systemic and regional tolerance to haemodilution during anaesthesia with two different synthetic colloids. Eighteen dogs undergoing mechanical ventilation during anaesthesia with ketamine were submitted to progressive normovolaemic haemodilution with either gelatin (GEL; n = 9) or hydroxyethylstarch (HES; n = 9) administered on a 1:1 ratio. Systemic oxygen delivery was calculated from measurement of thermodilution cardiac output and arterial oxygen content, while systemic oxygen consumption was determined from expired gas analysis. ⋯ The mesenteric critical oxygen extraction ratio (O2ER) (GEL 50.1 (12.1)%; HES 48.5 (13.4)%) was significant lower than the systemic critical O2ER (GEL 66.1 (8.4)%; HES 67.7 (7.1)%). There were no significant differences between the GEL and HES groups for any of these variables, or in the amount of colloid administered. During the study, oxygen delivery decreased almost linearly with reduction in haemoglobin, indicating a lack of cardiac output response to anaemia during ketamine anaesthesia.
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We have evaluated the intubating laryngeal mask airway (ILMA) for ventilation and for blind tracheal intubation. After induction of anaesthesia with fentanyl 1 microgram kg-1 and propofol 3 ml kg-1, the ILMA was placed successfully on the first attempt in all 100 patients. ⋯ Success was improved by pulling the metal handle of the ILMA towards the intubator in an "extension" manoeuvre, if intubation was not possible on the first attempt. These findings confirm the effectiveness of the ILMA in an Asian population.