A postal survey of all senior anaesthetists with routine commitment to an acute trauma list in 13 Scottish hospitals was conducted to delineate contemporary anaesthetic practice for hip fracture surgery. Almost equal use of general and regional anaesthesia was reported, however the techniques used for general anaesthesia were different from those described in previous literature in this group. The recently released Scottish Intercollegiate Guidelines Network (SIGN) guidelines for the management of elderly people with fractured hip state that seniority of anaesthetist is important for improved outcome but there is no difference between either general or regional anaesthesia. However these conclusions relate to techniques and drugs which are now rarely used during general anaesthesia for hip fracture surgery. Further work to assess the impact of new techniques and agents on outcome for this group of patients may be required.
Griffin S. Diabetes care in general practice: meta-analysis of randomised control trials. BMJ 1998;317:390-6. [With commentary by T Greenhalgh.] (8 August.) 2 Khunti K, Baker R, Lakhani M, Rumsey M. Quality of care of patients with diabetes: collation of data from multi-practice audits of diabetes in primary care. Family Pract (in press). 3 Hurwitz B, Goodman C, Yudkin J. Prompting the clinical care of non-insulin dependent (type II) diabetic patients in an inner city area: one model of community care. BMJ 1993;306:624-30. 4 Diabetes Integrated Care Evaluation Team. Integrated care for diabetes: clinical, psychological, and economic evaluation.
This article reviews the physiology and pathology associated with ageing and the impact these may have on the perioperative and anaesthetic care of the elderly trauma patient. The current literature on this subject is summarized and, based on this, recommendations are made for perioperative management.
SUMMARYWe report two cases where patients with an acute head injury developed hypercapnia as a result of the inappropriate use of the Magill breathing circuit. The Magill circuit is inefficient when used for controlled ventilation because the patient is ventilated with his own expired gas and develops hypercapnia. The suitability of alternative breathing systems are discussed.
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