SummaryWe compared two manoeuvres, jaw thrust and laryngoscopy, to open the airway during fibreoptic intubation in 50 patients after induction of anaesthesia in a crossover study. Patients were randomly allocated to receive either jaw thrust or conventional Macintosh laryngoscopy first. Airway clearance was assessed at both the soft palate and the epiglottis. Direct laryngoscopy provided significantly better airway clearance at the level of the soft palate than jaw thrust (44 (88%) vs 31 (62%), respectively; p = 0.002). At the level of the larynx, airway clearance was equally good in both groups (45 (90%) vs 46 (92%), respectively; p = 0.56). The times to view the larynx (median (interquartile range [range]) 4 (3-5 [2-35]) s vs 3 (3-4 [2-8]) s, respectively) and intubation time (20 (17-23 [11-83]) s vs 18 (15-20 [11-28]) s, respectively) were also similar.

SummaryComplications at extubation remain an important risk factor in anaesthesia. A postal survey was conducted on extubation practice amongst consultant anaesthetists in the United Kingdom and Ireland. The use of short acting drugs encourages anaesthetists to extubate the trachea at lighter levels of anaesthesia. The results show that oxygen (100%) is not routinely administered either before extubation or en route to the recovery area. A trend towards a head up or sitting position at extubation is emerging. However, further research into the use of these positions is required. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. The role of drugs such as propofol in decreasing the incidence of these complications needs further evaluation. Some of these results give concern for patient safety and for training. The importance of teaching and adherence to continued oxygenation until complete recovery is strongly emphasised. Nerve stimulators should be used continually as standard monitoring throughout the anaesthetic period when muscle-relaxing drugs are part of the anaesthetic technique. It has been shown that there are more adverse incidents associated with extubation than intubation and these are occurring not only during extubation itself, but also during the time spent in the recovery room [1][2][3][4][5]. The increased incidence of complications has been correlated with the pre-operative physical status, depth of anaesthesia at extubation, increasing age and gender with a male preponderance [2,6]. These complications remain consistent regardless of the type of operation [1].The problems associated with extubation may be broadly categorised into cardiovascular and respiratory complications. Cardiovascular complications include tachycardia, hypotensive and hypertensive episodes [7][8][9][10], which may be significant in patients with pre-existing ischaemic heart disease [11,12], pre-eclampsia [13] and in those undergoing neurological procedures [14]. Respiratory complications include local trauma, coughing, desaturation, breath-holding, masseter-spasm, laryngospasm, airway obstruction and aspiration [7,[15][16][17][18]].An on-line journal search revealed a lack of recent investigations or statistical data in these areas. This survey was performed with this in mind. The main aims of the survey were twofold. The first was to ascertain extubation practices with regard to the type of surgery, timing, position and techniques. The second was to estimate the incidence of problems associated with extubation and how these were treated. MethodsA postal survey was conducted in May 2004. A total of 845 Consultant Anaesthetists were randomly selected from the membership database of the Association of Anaesthetists of Great Britain and Ireland (AAGBI). These anaesthetists were sent the questionnaire, which they were asked to complete and return anonymously in the stamped, addressed envelope provided. The questionnaire (Fig. 1) was a structured document with...

SummaryFifty anaesthetists were recruited to use 20 different laryngoscope blades (one metal re-usable blade, five metal single-use blades and 14 plastic single-use blades, of which eight were bulbtype and 12 were fibreoptic-type) in a manikin to achieve a grade I Cormack and Lehane view. The anaesthetists were asked to provide visual analogue scores (VAS) for: ease of attachment of the blade to the handle; illumination; view of the larynx; and satisfaction for clinical use. The peak force applied and time to achieve the grade I Cormack and Lehane view were also measured. A cluster analysis method was used to group together blades with similar scores or measures.Ease of attachment, illumination, view, clinical use, force and duration were all significantly affected by the blade used (p < 0.0001 for all six). The mean peak force applied and mean duration for the 20 blades were 32-39 N and 4.4-9.5 s, respectively. All five metal single-use and four plastic single-use blades were always placed in the 'best' group in the cluster analysis. Two plastic blades provided a poor view and increased the duration of laryngoscopy.

A mixture of nitrous oxide and oxygen in equal proportions (Entonox or Equanox) is an effective analgesic and is considered safe with minimal side effects. The mixture is ideal for treating short term pain. We report a serious neurological problem in a patient using such a mixture to control pain from the daily packing of a large perineal cavity. Case reportA 21 year old man presented with a short history of being unable to stand. He had had a series of serious operations for the treatment for inflammatory bowel disease over a four year period-colectomy, ileostomy, and laparotomy with the formation of an ileoanal pouch. He developed pelvic sepsis requiring the laying open of an extensive perineal abscess.

Appropriate fluid therapy is essential to protect organ function in the perioperative period. The physiological principles of fluid and electrolyte management are well described but a gap exists between knowledge and clinical practice. In this article, we will review fluid and electrolyte physiology, the stress response to surgery and hypovolaemia, and the consequences of electrolyte disturbances.

There was a large variation in both performance and satisfaction between anaesthetists with each design. This highlights the importance of having a variety of face masks available for emergency use.

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