Forum 67coagulation at which the risk becomes clinically relevant are totally unknown. The results of this study, despite these limitations, may help to rationalise anaesthetic practice with regard to requests for coagulation screens on such patients. AcknowledgmentsWe thank Professor A.L. Bloom SummaryPain on injection of propofol was assessed in a controlled, randomised study of 273 patients. They received either lignocaine 10 mg, procaine 10 rng or isotonic saline 0.5 ml, 15 seconds before the injection of propofol into a vein on the back of the hand. The incidence of pain on injection in the'control group (51 %) was comparable with other studies. Lignocaine and procaine both significantly reduced the pain (35% and 34% respectively, p < 0.05) but there was no statistical difference between these two groups.
SummarySixty patients who requiredjbreoptic nasotracheal intubation were studied. Arterial oxygen saturation, arterial blood pressure and heart rate were monitored continuously duringjbreoptic intubation under deep halothane anaesthesia. There were significant decreases ( p < 0.001) in arterial blood pressure and heart rate despite administration of intravenous colloid and atropine. Almost one third of the patients (18 out of 60) suffered a decrease in arterial oxygen saturation below 90% during the intubation sequence and in five patients the saturation fell below 80%. The episodes of desaturation were not related to the induction-intubation time or to the grade of laryngeal visibility at direct laryngoscopy. Key wordsIntubation, tracheal; fibreoptic, difficult.The first report of the use of a flexible fibreoptic device as an aid to intubation of the trachea was by Murphy [l]. Flexible fibreoptic intubation of the trachea is now the method of choice when direct laryngoscopy is expected to be difficult. Awake fibreoptic intubation under topical anaesthesia is logical in such circumstances but most trainees are reluctant to attempt it until they have gained expertise in unconscious patients. We have used a method of fibreoptic intubation under general anaesthesia in which the patient breathes spontaneously throughout, both for training and in patients in whom awake intubation is unsuitable. This study investigates the arterial oxygen saturation (Spo,) and cardiovascular changes during fibreoptic intubation under general anaesthesia using a technique of spontaneous ventilation. MethodsSixty patients who required fibreoptic intubation before surgery for cervical spine disease were investigated in this study which had been approved by the local ethics committee. Patients in whom tracheal intubation by conventional methods was predicted to be difficult were included in the study. Criteria for inclusion were the presence of one of the following: Patil distance [2] < 5 cm; Mallampati score [3] 111; restricted or absent movement of the atlanto-occipital joint; evidence of temporomandibular joint dysfunction. Patients were not studied if it was anticipated that control of the airway would be difficult; these patients underwent awake fibreoptic intubation.Premedication with intramuscular papaveretum and hyoscine and with xylometazoline nose drops was administered 90 min before induction of anaesthesia.On arrival in the anaesthetic room continuous electrocardiograph and Spo, monitoring were initiated. A 16-gauge intravenous cannula and a 20-gauge arterial cannula were then inserted after infiltration with lignocaine 1 YO.Some patients received a small dose of midazolam (1-3 mg) during this procedure. The arterial blood pressure was monitored continuously via the arterial cannula and a pressure transducer. A hard copy of the arterial blood pressure, heart rate and Spo, measurements was made using a pen and chart recorder. Events during the intubation sequence were noted if they resulted in oxygen desaturation (Spo, < 90°!0)...
The density of a drug in solution cannot be determined from a simple formula or from physicochemical tables, because it depends on the physical state of that substance in solution. The densities of agents which have been reported to be administered by the intrathecal route were measured at room and body temperatures. The results were compared with the density of cerebrospinal fluid. At room temperature, most drugs were isobaric with respect to cerebrospinal fluid, but as drugs warmed to body temperature they became relatively hypobaric.
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