Cervical spine extension and time to intubation are similar for the Macintosh laryngoscope with ILS and the Bullard laryngoscope without ILS. However, time to intubation is significantly prolonged when the Bullard laryngoscope is used in a simulated emergency with cervical spine precautions taken. This suggests that the Bullard laryngoscope may be a useful adjunct to intubation of patients with potential cervical spine injury when time to intubation is not critical.

1 Using recently available selective agonists and antagonists we have examined further our postulate (Apperley et al., 1980) that 5-hydroxytryptamine (5-HT) mediates contraction of dog saphenous vein via a different 5-HT receptor type from that in the rabbit aorta. 2 In the rabbit isolated aorta, ketanserin and spiperone were potent, specific, competitively-acting antagonists of the contractile effects of 5-HT. 3 In contrast, in the dog isolated saphenous vein neither ketanserin nor spiperone caused any rightward displacement of concentration-response curves to 5-HT although the maximum response was reduced by about 10%. 4 In the rabbit aorta 5-carboxamidotryptamine (5-CONH2-T) was a weak agonist whilst the 5-N,Ndimethyl and 5-N-ethyl derivatives were even weaker or inactive. The contractile effect of 5-CONH2-T in the rabbit aorta was potently and competitively antagonized by ketanserin. 5 In contrast, in the dog saphenous vein 5-CONH2-T and its 5-N,N-dimethyl and 5-N-ethyl derivatives were all potent agonists. The contractile effect of 5-CONH2-T was not markedly affected by ketanserin. 6 The profile of action of ketanserin and spiperone in the rabbit aorta is consistent with the view that 5-HT2 receptors mediate contraction in this preparation. However, the 5-HT receptor mediating contraction in the dog saphenous vein appears to be '5-HT1-like', sharing a number of characteristics with the 5-HT, recognition site identified from [3H]-5-HT ligand binding studies in brain tissue.

To describe the use of recombinant activated factor VII (rFVIIa) in patients with life-threatening haemorrhage. We report a case series of Australian patients with life-threatening haemorrhage who were treated with rFVIIa prior to August 2002 namely 21 patients, median age 45 years (range 22-79 years), 33% (seven of 21) female. The major causes for bleeding were multi-trauma, cardiac or vascular surgery, or orthoptic liver transplantation. In the 24 h prior to the administration of rFVIIa, the median blood usage was 22 U packed cells (range 3-66 U), the median International Normalized Ratio was 1.6 (range 1.4-3.6) and the median activated partial thromboplastin time was 55 s (range 31-180 s). During the 24 h after administration of rFVIIa, the median blood usage was 2 U packed cells (range 0-16 U), the median International Normalized Ratio was 1.0 (range 0.9-1.2) and the median activated partial thromboplastin time was 40 s (range 30-94 s); P < 0.001 for each comparison. Sixteen of the 21 patients were discharged from hospital or were alive at 30 days. There were no thrombotic complications following the administration of rFVIIa. These uncontrolled data suggest a role for rFVIIa as an adjunctive haemostatic measure in surgical patients with life-threatening haemorrhage for whom conventional measures to achieve haemostasis have failed.

No abstract

Compared with remifentanil 0.0625 microg x kg(-1) x min(-1) and 0.250 microg x kg(-1) x min(-1), a remifentanil infusion rate of 0.125 microg x kg(-1) x min(-1) provided more stable hemodynamic conditions during intracranial surgery under desflurane anesthesia.

The effect of 5‐hydroxytryptamine on contractile responses to sympathetic nerve stimulation has been studied in the dog isolated saphenous vein. Electrical stimulation (0.1 to 10 Hz) of dog saphenous vein strips produced frequency‐dependent contractions. Contractions produced by stimulation at 2 Hz were almost completely blocked by tetrodotoxin (3.1 × 10−8 mol/l) or phentolamine (5.0 × 10−6 mol/l) but mecamylamine (5.0 × 10−6 mol/l) had little effect. This suggests that the contractions were mediated predominantly through noradrenaline release from postganglionic noradrenergic nerves. Contractions produced by intermittent electrical stimulation at 2 Hz were inhibited by 5‐hydroxytryptamine (1.0 × 10−9 to 1.0 × 10−7 mol/l) in a concentration‐dependent manner whilst contractions induced by exogenous noradrenaline were not affected. The inhibitory action of 5‐hydroxytryptamine was most marked at low frequencies of stimulation and with low pulse numbers. High external calcium concentrations (3.9 and 5.2 × 10−3 mol/l) reduced the inhibitory action of 5‐hydroxytryptamine. Cyproheptadine (1.0 × 10−8 mol/l to 1.0 × 10−6 mol/l) or morphine (1.0 × 10−7 mol/l to 1.0 × 10−5 mol/l) did not antagonize the inhibitory action of 5‐hydroxytryptamine. Methysergide (1.0 × 10−7 mol/l) slightly reduced the contractions produced by electrical stimulation and only weakly antagonized the action of 5‐hydroxytryptamine. It is suggested that a 5‐hydroxytryptamine receptor exists presynaptically in the dog isolated saphenous vein strip and that stimulation of this receptor by low concentrations of 5‐hydroxytryptamine inhibits the release of noradrenaline from noradrenergic nerves. This receptor type is resistant to blockade by ‘classical’ 5‐hydroxytryptamine antagonists.

The TEG V R 5000 and novel TEG V R 6s measure the viscoelasticity of whole blood during in vitro clot formation. The two devices measure similar coagulation variables but utilize distinctly different technologies. This study aimed to determine the correlation and agreement between the thrombelastographic parameters obtained by the two devices during liver transplant surgery. We obtained blood samples at six predefined intervals during the surgery of 10 consecutive patients. Two operators proficient in the use of the TEG V R 6s and TEG V R 5000 systems performed thrombelastographic measurements on each sample: non-citrated TEG V R 5000, citrated TEG V R 5000 and citrated TEG V R 6s. Agreement and correlation were assessed using Bland Altman plots and Lin's concordance correlation. There was considerable inter-device variability for the different parameters measured by the TEG V R 5000 and TEG V R 6s devices. Acceptable agreement was observed when results were within the normal reference ranges. However, with increasing coagulopathy, agreement was poor and results could not be considered interchangeable. Although each of the three tests appeared reliable for qualitative detection of abnormalities of clot formation during liver transplant surgery, we found their quantitative results were not interchangeable.

Ten junior doctors with no postgraduate anaesthetic experience attempted to ventilate the lungs of 50 anaesthetized patients, using either a laryngeal mask or a Guedel airway and face mask. Success was defined as the production of two successive tidal volumes exceeding 800 ml within 40 s. The failure rate was significantly greater using the laryngeal mask compared with the face mask (P < 0.05) and the average time was significantly longer with the laryngeal mask than with the face mask (P < 0.01). The results from this investigation suggest the laryngeal mask airway cannot be recommended as a resuscitation device for use by inexperienced operators.