The aim of the present study was to examine the effectiveness of tunnelled pleural catheters (TPC) in patients with malignant pleural effusions who would otherwise be candidates for pleurodesis.Patients were selected from a previously reported database of 250 TPC insertions. The study group was selected based on lung re-expansion and survival as a surrogate maker of eligibility for pleurodesis procedure, as defined by survival of o90 days and lung re-expansion o80% postdrainage on a standard chest radiograph 2 weeks post TPC placement.There were 109 procedures in 97 patients that met the entry criteria. Spontaneous pleurodesis (SP) was achieved following 70% of procedures and correlated with symptom control. The mean time to SP was 90 days. There was no need for a repeat procedure in 87% of cases overall and in 92% of patients experiencing SP. There were few complications and no procedure-related deaths.Tunnelled pleural catheters are an effective way of controlling malignant pleural effusions when used as first-line treatment in patients who appear to be candidates for pleurodesis procedures.

SummaryW e report the management of anaesthesia for Caesarean section in a woman with severe extensive tracheal stenosis. Management was initially with spinal anaesthesia, but general anaesthesia became necessary as a result of profuse intra -operating bleeding. We describe the use of the Hayek oscillator cuirass ventilator to allow instrumentation of the larynx whilst maintaining respiratory support, and for weaning from mechanical ventilation.

A case of spontaneous rupture of the tympanic membrane during anaesthesia is reported and its possible aetiology discussed.

ForumSingle breath end-tidal Pco, measurement during high frequency jet ventilation in critical care patients C.J. Mason, MB, ChB, FFARCS, Senior Registrar, Manchester Royal Infirmary, Oxford Road, Manchester. SummaryThe relationship between arterial and end-tidal carbon dioxide tensions following a single large breath was investigated in seven critically ill patients receiving high frequency jet ventilation. There was a close correlation (r = 0.989) between arterial and end-tidal carbon dioxide tensions over a wide range (3.29-8.95 kPa). Measurement of the end-tidal carbon dioxide tension following a single large breath may be useful in monitoring the eficiency of high frequency jet ventilation in the elimination of carbon dioxide.

A randomized, double-blind comparison of nalbuphine 30 mg or 60 mg by mouth and dihydrocodeine 30 mg by mouth was conducted in 75 patients with moderate to severe pain after surgery for dental extractions under general anaesthesia. A significant reduction in pain intensity followed each treatment and persisted throughout the 4-h observation period after nalbuphine, but only for 3 h after dihydrocodeine was given. Reduction in pain intensity was significantly greater 2, 3 and 4 h after the use of nalbuphine 60 mg than following dihydrocodeine 30 mg, and the mean total pain intensity difference was greater following nalbuphine 60 mg than following dihydrocodeine. Nalbuphine 60 mg effectively provided complete or good pain relief in more than 50% of the patients and only three patients in this group required additional analgesia during the period of observation, compared with nine patients in each of the other groups. However, the patients who received nalbuphine 30 mg had a significantly higher mean pain intensity before treatment than those in the other groups. The side-effects encountered were those typical of opioid medication; there were no statistically significant differences between the groups.