SummaryThe aim of this study was to investigate the performance of awake fibreoptic intubation using remifentanil sedation with topical anaesthesia limited only to the nasal mucosa. Twenty-four patients presenting for elective head and neck surgery were sedated using remifentanil titrated to effect and local anaesthetic was applied to the nasal mucosa. Vital signs were recorded throughout the procedure and both the anaesthetist and an observer rated the ease of the procedure. Intubation was successful in all patients and the procedure was rated as easy in 15 (63%) of patients. Mean arterial pressure remained within 8% of baseline in all cases and respiratory rate remained > 8 breaths.min )1 in all but three patients. Although 56% of patients interviewed postoperatively said they recalled the procedure, all but one would undertake the same procedure again if necessary. This technique appears reliable in providing adequate sedation whilst maintaining cardiovascular and respiratory stability.
SummaryWe investigated the effect of temperature on single use and reuseable bougies. In a photographic study, three bougies (Portex Ò Venn reuseable (R), Portex single use (S) and Breathesafe TM single use (B)) were exposed to increasing temperatures and sequential photographs were taken of the bougies uncoiling from a preformed curve. Bougie type was associated with rate of uncoiling, type R maintaining its curve the longest but changing temperature did not affect this. In a randomised cross-over manikin study, 16 anaesthetists attempted to pass two bougies (Portex reuseable (R) and Portex single use (S)) at three temperatures (10, 20 and 30°C) into the trachea of a manikin. Type R was significantly associated with higher success rate of tracheal placement compared to type S. Change of temperature was significant with success rate increasing with lower temperature. The odds of success at 10°C was six times that at 30°C (OR (95%) 6.7 (1.7, 25.7)). We concluded that both bougies performed best at 10°C.
Cell salvage, the process whereby blood is suctioned from the surgical site then filtered, centrifuged and washed before being transfused, was first developed in 1974. Since then it has become a widely used technique which reduces the need for allogenic blood transfusion. Cell salvage was initially considered to be contraindicated in obstetrics, because of the risk of amniotic fluid emboli, in potentially 'dirty' surgical sites and in oncological surgery because of concerns about re-transfusion of malignant cells. However, cell salvage is now routinely used in obstetrics, particularly in massive haemorrhage, and in elective bowel resection. The potential use of cell salvage in oncological surgery has been highlighted following the National Institute for Health and Clinical Excellence (NICE, 2008) guidance sanctioning (although not specifically recommending) cell salvage during radical prostatectomy and cystectomy. This leads to the question of whether cell salvage is safe to use in these and other types of oncological surgery.
3apid sequence induction (RSI) with succinylcholine has been the mainstay of obstetric general anaesthetic practice for over 40 years. This aims to provide rapid intubating conditions in patients at risk of regurgitation. Failed intubation in obstetrics is ten times more common than in the general population although most parturients do not have a predicted difficult airway. This article explores whether traditional RSI with succinylcholine is still the method of choice for caesarean section.
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