A technique of total intravenous anaesthesia using etomidate by bolus intravenous (IV) injection for induction and by continuous intravenous infusion for maintenance of anaesthesia, with supplementary intravenous fentanyl analgesia, is described. Muscle relaxation was provided by competitive neuromuscular blockade, allowing controlled ventilation of the lungs with oxygen-enriched air. Arterial blood pressure, heart rate and rhythm remained stable throughout the procedure. Few complications were encountered of which the most significant was a 13% incidence of nausea and/or vomiting. Pain on injection, abnormal muscular movements on induction, and post operative venous sequelae were uncommon. Patients were easily rousable shortly after termination of drug infusion. The technique proved acceptable to the patient, surgeon and experienced anaesthetist and, thereby, would appear to offer a reasonable alternative to the more conventional inhalational anaesthetic technique.
The use of double-lumen endobronchial tubes is indicated for a variety of procedures in thoracic surgery. One such operation is repair of traumatic rupture of a main-stem bronchus. To ensure adequate ventilation of the contralateral lung during the bronchial anastamosis, satisfactory separation of the lungs is required.As bronchial disruption results in nonventilation of that lung, confirmation of accuracy of tube placement cannot be obtained by conventional means. Two cases of traumatic bronchial rupture are reported in which clinically unsuspected malposition of the double-lumen tube was diagnosed using fibreoptic bronchoscopy. Later in the procedures, the endoscope again proved useful by assisting the surgeon to identify the proximal bronchial stump.CASE REPORTS Case 1. A 38-kg 15-year-old boy was referred from a peripheral hospital having fallen from a tractor some five weeks previously. A left-sided haemothorax having been suspected, an intercostal tube had been inserted with no return or improvement. After referral it was noted that the radiological *F.
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