Summary

Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. Intra-cuff pressures were compared to assess any change due to inward diffusion of nitrous oxide. The incidence of significant sore throat and/or hoarseness overall was 15.0%. There was no statistically significant difference between the groups (air 15.9%, saline 14.5%). In the air group mean intra-cuff pressure increased significantly (start 14.0 mmHg, end 40.9 mmHg), while in the saline group there was no significant increase (start 12.7 mmHg, end 14.6 mmHg). The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied.

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)...

This prospective, controlled study was undertaken to determine whether addition of adrenaline or fentanyl to bupivacaine or warming of the injectate had any effect on the incidence of shivering following extradural analgesia in the labouring parturient. Eighty-four patients were sequentially allocated to four groups (control, warm injectate, extradural adrenaline and extraduralfentanyl). The adrenaline group had the highest incidence of shivering, the warm injectate and fentanyl groups the lowest. Extradural fentanyl also seemed promising in reducing shivering in pre-block shiverers. This paper also explores the rapidity of temperature decay of solutions ofbupivacaine in different clinical situations.