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Key wordsTrachea; stenosis. Intubation, tracheal; complications Case historyA healthy 16-year-old girl who weighed 56 kg presented for planned surgical correction of an idiopathic thoracic scoliosis by internal fixation. The deformity was first noted at the age of fifteen and apart from a congenital reduction deformity of her left arm she was physically fit. However on further questioning she did admit to occasional wheezy episodes and routine pre-operative pulmonary function tests confirmed mild obstructive airways disease.Premedication was papaveretum (10 mg) and hyoscine (0.2 mg) given one hour pre-operatively. Anaesthesia was induced with thiopentone (250 mg) followed by pancuronium (6 mg) to facilitate orotracheal intubation. The vocal cords were sprayed with 4% lignocaine and intubation was attempted with an 8.5 mm cuffed armoured latex orotracheal tube. The tip passed easily through the cords but was held up about 2 cm lower down the trachea. The size of the tube for tracheal intubation was progrcssivcly reduced until a 5.0 mm one passed the obstruction. However ventilation of the lungs was unsatisfactory because the tube was relatively short. It was decided to assist ventilation using a Guedel airway, face mask and Bain system and ventilation was easy and unobstructed. The patient's condition remained stable and residual curarisation was reversed using neostigmine (5.0 mg) and atropine (1.2 mg) when slight muscle movements were noted 35 minutes after induction. The patient made a complete and uneventful recovery. In view of the difficulties encountered it was felt that major surgery could not be considered at this stage.At a later date an ENT examination with indirect laryngoscopy revealed normal vocal

Ectopic pregnancy poses a diagnostic and therapeutic challenge; however, advances in ultrasound technology and its applications have provided the capability to diagnose ectopic pregnancy at a very early stage. This article offers an update on the various specific and non-specific ultrasound diagnostic criteria used in the diagnosis of ectopic pregnancy.

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