A reservoir bag for the Triservice anaesthetic apparatus

Abstract

suggested guidelines. Secondly, the ACC ⁄ AHA guidelines state that a patient with uncontrolled systemic hypertension (minor clinical predictor) without compromised heart function or signs of coronary heart disease can generally proceed safely with a scheduled operation for low risk surgery [1]. Thirdly, the 'drastic' fall in blood pressure in our patient occurred in the surgical ward without any intervention and therefore was most likely due to a reduction in pre-operative anxiety. The signs of left ventricular hypertrophy were quite mild and without evidence of left ventricular strain. The signs of chronic hypertensive heart disease were not evident on echocardiography. Fourthly, the fluctuating blood pressure and unstable haemodynamics in theatre and, possibly, the signs of left ventricular hypertrophy were due to the thyroid storm, and not an underlying chronic cardiac condition or so-called 'white-coat' hypertension. The aforementioned ACC ⁄ AHA guidelines do not mention thyroid function in preoperative risk assessment and our case report was a timely reminder. Finally, the operation was postponed and performed later after treatment of the thyroid storm.

A reply

“…On the matter of the control group, we explain in the paper the difficulties encountered in recruiting a truly comparable group of control children and point out the similar difficulties reported by previous investigators [1]. We would note that of the five other papers in the literature concerning paediatric postoperative cognitive function, two recruited non-hospitalised control children [1,2], whilst the other three did not include control groups [3][4][5].…”

“…We would note that of the five other papers in the literature concerning paediatric postoperative cognitive function, two recruited non-hospitalised control children [1,2], whilst the other three did not include control groups [3][4][5]. The same is true of a large proportion of studies of anaesthetic recovery in adults.…”

“…The effects of general anaesthesia on children I am concerned about the title of the paper by Millar et al [1] which purports to address the 'effects of sevofluranenitrous oxide anaesthesia on children's postoperative cognition and behaviour'. This research looked at such variables as sore mouth, crying, nightmares and tantrums in the week following dental surgery.…”

Sub‐mental vs. retromolar intubation

“…The latest review of the ASA Closed Claims Project Database in 2004 showed that burns from warming devices accounted for 23% of claims relating to intra-operative burn injury [1]. We have had 3 years complicationfree experience with the Suntouch warmer and have found it to be very useful.…”

“…I read with interest Birt's suggestion that the Triservice Anaesthetic Apparatus should be configured with a reservoir bag in place of the open ended tube [1]. Having succeeded the author to a field hospital in an operational setting, I can affirm its usefulness and welcome Houghton's support for it [2].…”