SummaryA modified version of the Cormack and Lehane scoring system was prospectively evaluated in 663 patients requiring tracheal intubation. In the modified system, grade 2 (only part of the glottis visible) was divided into 2a (part of the cords visible) and 2b (only the arytenoids or the very posterior origin of the cords visible). One hundred and sixty-two intubations (24.4%) were scored as grade 2a and 43 (6.5%) as grade 2b, of which seven (4.3%) and 29 (67.4%), respectively, were difficult, defined as requiring more than one laryngoscopy or the use of specialist equipment. Grade 2b denotes a laryngoscopic view that is relatively common and is often associated with difficulty passing a tracheal tube. The modified scoring system thus provides more information than the original Cormack and Lehane system and its use should be considered when recording the ease of tracheal intubation in the anaesthetic record or in studies of tracheal intubation.

SummaryManagement of the airway is central to the practice of anaesthesia, yet trainees frequently feel poorly trained in this area. A large range of skills needs to be acquired, but there are often problems providing training on live patients. We review the different modalities available for training and assessment in airway management.

No abstract

SummaryWe have evaluated the TEG Ò thromboelastograph and the ROTEM Ò thromboelastometer, two point-of-care devices that measure blood coagulation. During a one-week period, seven consultant anaesthetists, one consultant haematologist, one associate specialist anaesthetist and two senior trainee anaesthetists were trained by the manufacturers and set up, calibrated and used both systems, after which their views were obtained and specific technical/support information was sought from the manufacturers using a questionnaire. Although the devices shared common features, they differed in complexity and aspects of ease of use, and in their purchase and running costs. Figure 1 The TEG Ò thromboelastography system. Two units are shown on the right of the separate (but connected) laptop computer, each with two sampling channels.

We have studied the effect of P6 acupuncture on postoperative vomiting in 45 children undergoing tonsillectomy. After induction of anaesthesia and before the start of surgery, 50% of the patients received P6 acupuncture (in the middle of the ventral surface of the wrist) for 5 min. There was no difference in the incidence of vomiting between the acupuncture (39%) and non-acupuncture (36%) groups. We conclude that, when administered after induction of anaesthesia, P6 acupuncture is ineffective in reducing vomiting after tonsillectomy in children.

SummaryMathematical formulae to calculate body surface area from measurements of height, weight and other parameters date from the late 19th century. Drug doses, fluid therapy, caloric requirements and physiological parameters such as cardiac output, glomerular filtration rate and a variety of respiratory function parameters are all frequently expressed in terms of a body surface area. Body surface area is often used in preference to body mass (weight). However, the original rationale for using body surface area as an estimate for metabolic rate has never been tested and the algorithms used to approximate body surface area have little evidence to support their use in this role. Recent developments in technology using indirect calorimetry allow easy measurement of metabolic rate in the clinical setting. Such measurements should be used for standardisation when weight alone is considered inadequate.Keywords Body surface area. Metabolic rate. Calorimetry. Rubner's Law, published in 1883, crystallised a belief among physiologists in the mid to late 19th century that, regardless of species, the heat production (i.e. metabolic rate) of an individual was proportional to the body surface area (BSA) [1]. This law was very difficult to disprove because BSA could only be measured by very cumbersome means, such as skinning the subject. Measurement of metabolic rate via direct calorimetry was possible but not widely available. Being unable to measure the metabolic rate in a clinical setting, measuring BSA seemed to provide an acceptable alternative to metabolic rate. There was an impetus around the beginning of the 20th century to derive simpler ways of calculating BSA using mathematical manipulations of various body dimensions. Throughout the remainder of the century, investigators attempted to simplify the equations and expand the application of the formulae. Because of the importance and widespread use of BSA formulae in many areas of medicine, we undertook a literature review to determine the source of and evidence for these equations. MethodsComprehensive literature reviews of documents published around 100 years ago are difficult. The electronic database ÔMedlineÕ only includes publications from 1966 onwards, whilst its paper-based predecessor, Index Medicus, extends to only 1960. The Medline database was searched by combining a medical subject heading (MeSH) search for Ôbody surface areaÕ, which prior to 1970 was classified under ÔanthropometryÕ. The following search strategies were used: MeSH search for ÔmathematicsÕ, or keyword searches for Ôcalculat*Õ, ÔformulaÕ or ÔduBoisÕ (duBois being the author of the most widely used BSA formula). Index Medicus was searched using the ÔanthropometryÕ MeSH term. Documents prior to 1960 were found from the references in articles identified by Anaesthesia, 2003, 58, pages 50-83 Ó 2003 Blackwell Publishing LtdMedline and each relevant document prior to 1960 also had its references searched. The development of Ôheight)weightÕ formulaeThe first published equation for estimating B...

The antiemetic effects and side-effects of P6 acupuncture and droperidol pre-treatment were evaluated in a randomized, patient-and observer-blinded

SummaryWomen in labour receiving epidural analgesia with 15 ml bupivacaine 0.1% and 2 lg.ml )1 fentanyl followed by 10-15-ml top-ups as required, who needed Caesarean section, were randomly allocated to receive 20 ml levobupivacaine 0.5% over 3 min with either 75 lg fentanyl (1.5 ml) or 1.5 ml saline. Further top-ups or inhaled or intravenous supplementation were given for breakthrough pain. Time to onset (loss of cold sensation to T4 and touch sensation to T5 bilaterally), quality of analgesia and side-effects were recorded. The study was stopped after 112 patients had been randomly assigned, due to a unit protocol change, from midwife-administered top-ups to patient-controlled epidural analgesia. Data from 51 patients given fentanyl and 54 given saline were available for analysis. There were no significant differences in onset times or supplementation between the groups, but there was more intra-operative nausea ⁄ vomiting with fentanyl (53%) than with saline (18%; p = 0.004). We found no advantage of adding fentanyl to epidural levobupivacaine when extending epidural analgesia in women already receiving epidural fentanyl during labour and there was an increased incidence of intra-operative nausea and vomiting. Power analysis suggested the same conclusion even had the study proceeded to completion.