No abstract

We conducted a prospective, randomized study to assess the impact of cell salvage, auto transfusion on the requirements for allogeneic blood for patients undergoing a total knee replacement (TKR). One hundred consecutive TKR patients were randomly allocated to receive either autologous blood (using cell salvage) or an allogeneic blood transfusion as necessary. Patients allocated to the autologous group were rescued with allogeneic blood if the postoperative haemoglobin fell below 9 g dL-1. Forty-two (84%) of 50 patients in the autologous group required no supplementary blood transfusion. Forty (80%) of 50 patients allocated to receive allogeneic blood required transfusion. There were no detrimental effects of autologous blood transfusion. We conclude that autologous blood transfusion, using the cell saver system, is a safe and effective method of reducing the need for allogeneic blood transfusion and, in doing so, reduces the risk of transmission of infections associated with allogeneic blood transfusion, whilst decreasing demand on precious allogeneic blood reserves.

SummaryPrevious studies reported that complications associated with removal of the laryngeal mask were more frequent in awake patients than in anaesthetised patients; however, these studies did not comply with the method described in the manufacturer's instruction manual. The reported incidences of regurgitation during the use of the laryngeal mask also differ considerably between studies. We studied these factors in 66 patients in whom the method described in the manual was used. After induction of anaesthesia, the laryngeal mask and a pH probe were inserted and the cuff of the mask was inflated with a minimum volume of air. Anaesthesia was maintained with nitrous oxide and isoflurane in oxygen. At the end of the operation, we randomly allocated patients to one of two groups and the laryngeal mask was removed either while they were still deeply anaesthetised or after they had regained consciousness. No apparent regurgitation occurred in any patient during operation, but one patient in the anaesthetised group regurgitated immediately after removal of the mask. The incidence of complications during or after removal of the laryngeal mask was significantly greater in the anaesthetised group than that in the awake group (p << 0.001; difference [95% CI]: 48.5 [30.5-66.5]%). Therefore, the laryngeal mask can be safely left in place until the patient has regained consciousness after emergence from anaesthesia.

Using CO2 for DCBE is recommended as it may decrease pain afterwards but recent studies suggest it produces inferior distension. This prospective double blind study was designed to evaluate the use of an air/CO2 mixture. We randomised 105 patients to receive air, CO2 or a 50/50 mixture as the insufflation agent in DCBE. Gases were administered from prefilled bags. Those requiring additional insufflations before over couch films were recorded. Post procedure symptoms were evaluated by questionnaire. Distension and mucosal coating were assessed independently. There was no difference in mucosal coating. Those given CO2 had significantly less immediate and delayed pain compared to air and less delayed pain compared to the 50/50 mixture. Distension with air was graded better than with the other two agents but the difference did not reach statistical significance. However 50 % of patients receiving CO2 and 40 % of those receiving the mixture required additional insufflation before over couch films as distension was considered suboptimal, compared to 17 % of those given air, which was statistically significant. Our results indicate that using CO2 causes less pain than using air or the mixture although top up insufflations are often required to maintain adequate quality distension.

The laryngeal mask airway (LMA) has been used extensively to provide a safe airway in spontaneously breathing patients who are not at risk from aspiration of gastric contents. The role of the LMA in the event of a failed intubation in an obstetrical patient, and its place in a failed intubation drill remains unclear. Two hundred and fifty consultant obstetric anaesthetists in the United Kingdom were asked to complete an anonymous questionnaire regarding their views about using the laryngeal mask airway (LMA) in obstetrical anaesthesia. The LMA was available in 91.4% of obstetric units. Seventy-two per cent of anaesthetists were in favour of using the LMA to maintain oxygenation when tracheal intubation had failed and ventilation using a face mask was inadequate. Twenty-four respondents had had personal experience with the LMA in obstetrical anaesthesia, eight of whom stated that the LMA had proved to be a lifesaver. We believe that the LMA has a role in obstetrical anaesthesia when tracheal intubation has failed and ventilation using a face mask proves to be impossible, and it should be inserted before attempting cricothyroidectomy.

SummaryThis study assessed a tried, but previously unpublished, method of internal jugular vein cannulation in 50 patients scheduledfor elective cardiac surgery. The method involves using two landmarks: the larynx (thyroid and cricoid cartilages) together with the carotid artery (if it is palpable). The cricoid and thyroid cartilages were readily identiJable in 48 (96%) patients. The carotid artery was palpable in 45 (90%) patients, although some d@culty in palpation was recorded in 24 (48%) patients. There was a 98% success rate of venous cannulation. In 90% of cases the 21 gauge seeker needle entered the vein on the first or second attempt, and in 82% of cases the subsequent 18 gauge introducing needle entered the vein on thejirst attempt.

No abstract

SummaryIn a double-blind randomised trial, 122 female smokers undergoing elective surgery were allocated to receive one of two prerecorded messages while fully anaesthetised. The active message was designed to encourage them to give up smoking whilst the control message was the same voice counting numbers. No patient could recall hearing the tape. Patients were asked about their postoperative smoking behaviour one month later. Significantly more of those who had received the active tape had stopped or reduced their smoking ( p < 0.01). This would suggest a level of preconscious processing of information.