British journal of anaesthesia
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Case Reports
Retrieval of a retrograde catheter using suction, in patients who cannot open their mouths.
In difficulty, tracheal intubation can be facilitated by passing a retrograde catheter, but the mouth has to be opened for the retrieval of the catheter from the pharynx. Two patients with ankylosis of a temporomandibular joint were unable to open their mouth, and required general anaesthesia for gap arthroplasty. ⋯ Catheter-guided tracheal intubation was done without complication. A suction catheter can assist retrograde retrieval of a catheter to aid intubation in patients who cannot open the mouth.
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Early warning scores using physiological measurements may help identify ward patients who are, or who may become, critically ill. We studied the value of abnormal physiology scores to identify high-risk hospital patients. ⋯ Simple physiological observations identify high-risk hospital inpatients. Those who die are often inpatients for days or weeks before death, allowing time for clinicians to intervene and potentially change outcome. Access to critical care beds could decrease mortality.
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Letter Case Reports
Bupivacaine in the sub-Tenon's space to relieve postoperative pain in a child.
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Carcinoid syndrome creates many challenges during anaesthesia, including hypertension, hypotension and bronchospasm. These challenges are less common and less severe after the routine use of octreotide. ⋯ The combination of perioperative octreotide administration, intraoperative remifentanil infusion and sevoflurane anaesthesia, with postoperative epidural analgesia proved satisfactory. We review the recent literature and suggest that remifentanil is a useful addition to the armamentarium of the anaesthetist in the management of a patient with carcinoid syndrome.