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These findings have significant implications for the use of CO2 insufflation for laparoscopy in patients with a compromised respiratory or cardiac status.

The laryngeal mask airway reduces blood flow in the common carotid artery bulb Purpose: The introduction of the laryngeal mask airway (LMA) has had a major impact on anaesthetic practice in the last ten years. Previous authors have demonstrated pressures equivalent to mean arterial blood pressure within the cuff of the LMA. This study examined the effects of cuff inflation on the cross sectional area, flow and velocity of blood flow at the level of the carotid sinus.Methods: Seventeen patients scheduled to have LHAs inserted as part of routine anaesthetic management were recruited into the study. Measurements of the common carotid artery bulb area, peak velocity and blood flow were performed upon LMA cuff inflation and deflation using a 5 HHz pulse wave Doppler probe.Results: Deflation of the cuff resulted in an increase in the cross sectional area (from 0.58 ---0.05 to 0.64 ___ 0.04 cm2; P < 0.005), an increase in blood flow (from 65.6 ---5.6 to 73.9 ___ 5.6 cm3"sec-i; P < 0.05) and a slight but non significant increase in velocity of blood flow.Conclusion: This study demonstrates that inflation of the cuff on the LIVlA results in a decrease in carotid bulb cross sectional area which results in a decrease in blood flow.

Purpose: Cardiac perforation is a recognised complication of guidewire-introducer techniques. These two new cases of right ventricular perforation implicate the dilator-introducer: one directly and the other due to presumed guidewire buckling.Clinical Features: An 85-yr-old man underwent fight subclavian cannulation for triple-lumen and pulmonary artery (PA) catheter insertion before coronary artery surgery. Tachycarclia (120 bpm) and hypotension (60130 mmHg) evolved over the next 40 rain and resolved with evacuation of 200 ml of clot from the pericardial sac. A ragged 4 mm laceration of the ventricular wall was localised and oversewn without further consequence.A 60-yr-old man with inferior vena caval thrombosis was scheduled for Greenfield filter insertion. The right internal jugular vein was cannulated using the guidewire-introducer technique. Introduction of the introducer-dilator system precipitated cardiovascular collapse. Resuscitation was unsuccessful and post-mortem revealed right ventricular perforation and pericardial tamponade.Conclusion: These cases suggest that shorter introducer-dilators would be safer and probably equally efficacious. The need for a high index of suspicion and rapid therapeutic intervention is also highlighted.Objectif : La perforation cardiaque est une complication bien connue de l'utilisation du guide m~taJlique pour le cath&Erisme. Deux cas de perforation ventriculaire droite mettent ici en cause le dilatateur-introducteur dont la premiere directement, la deuxiEme par enroulement possible du guide m~taJlique. Conclusion : Ces cas portent h croire que que des introducteurs-dilatateurs plus courts seraient moins dangereux et peut-&re aussi efficaces. La nEcessitE de demeurer vigilant et d'intervenir rapidement est soulign4e.

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