A NEW TECHNIQUE FOR DOMICILIARY FLYING SQUAD ANAESTHESIA

A technique of domiciliary midwifery anaesthesia using Entonoxon a demand basis and minimal trichloroethylene is described.The method employs apparatus using the drawover principle, andalso includes facilities for neonatal resuscitation. ^*Liverpool Maternity Hospital, Liverpool 7. Department of Anaesthetics, Bristol University. Whiston Hospital, Prescot, Lanes.     

ACUTE GASTRIC DILATATION IN AN INCARCERATED HIATUS HERNIA

A case is reported of an unusual complication in which acutegastric dilatation occurred in an incarcerated hiatus hernia,resulting in left ventricular failure in the postoperative period.Failure to recognize this gave rise to concern when the patientre-presented for further surgery. ^*Department of Anaesthesia, Royal Liverpool Hospital, PrescotStreet, Liverpool L7 8XP. Walton Hospital, Rice Lane, Liverpool L9 1AE.     

EFFECTS OF ANAESTHETIC TECHNIQUE ON DEEP VEIN THROMBOSIS: A Comparison of Subarachnoid and General Anaesthesia

Forty patients with fractured neck of femur were allocated randomlyto undergo surgery under general anaesthesia (GA) or subarachnoidanaesthesia (SAB). After operation, the incidence of deep veinthrombosis (DVT), assessed by venography, was found to be 40%in the SAB group, which was significantly lower than the incidence(76.2%) in the GA group. These observations may account forthe previously reported effect of SAB, in comparison with GA,in reducing early postoperative mortality in this category ofpatient. ^*Nuffield Department of Anaesthetics, Radcliffe Infirmary,OxfordOX2 6HE. Department of Orthopaedic Surgery, Royal Liverpool Hospital,LiverpoolL7 8XP. University Department of Anaesthesia, Leicester Royal Infirmary,Leicester LEI 5WW.     

DELAYED EXCITATORY REACTION FOLLOWING INTERACTION OF COCAINE AND MONOAMINE OXIDASE INHIBITOR (PHENELZINE)

A case report is presented in which a patient receiving themonoamine oxidase inhibitor, phenelzine, developed a delayedexcitatory reaction following administration of topical cocainespray during anaesthesia for vocal cordsurgery. The pharmacologicalbasis of the drug interaction is discussed. ^*Department of Anaesthesia, St Bartholomew's Hospital, WestSmithfield, London EC1A 7BE. Shackleton Department of Anaesthetics, Southampton General Hospital,Tremona Road, Southampton S09 4XY. Harefield Hospital, Uxbridge, Middx UB9 6JH.     

A CASE OF MASSIVE ASPIRATION OF GASTRIC CONTENTS DURING OBSTETRIC ANAESTHESIA: Treatment by Tracheostomy and Prolonged Intermittent Positive Pressure Ventilation

A case is described of massive aspiration of liquid gastriccontents into the lungs of an obstetric patient undergoing generalanaesthesia. Pre-operative treatment with oral alkali to neutralizegastric acid did not prevent a severe reaction in the lungs.Treatment was by general supportive measures and long-term intermittentpositive pressure ventilation via a tracheostomy. Great difficultywas experienced in ventilating the lungs because of their lowcompliance and the large physiological deadspace. Recovery wascomplicated by a severe reduction in pulmonary diffusing capacityand by the development of tracheal stenosis. The factors influencingthe treatment and complications are discussed. ^*Present addresses:United Oxford Hospitals Present addresses:Tottenham Group of Hospitals Present addresses:St. George's Hospital, London     

METHOXYFLURANE ANALGESIA FOR BURNS DRESSINGS: EXPERIENCE WITH THE ANALGIZER

Methoxyflurane has been used to provide analgesia for burnsdressings on sixty occasions in eleven patients. It was administeredby way of a new, disposable vaporizer, the Analgizer, whichis described. Three patients required either supplementary analgesicsor tranquillizers. No side effects were noted, and patient acceptanceof the Analgizer was good. This method is thought to representan advance over previous methods of analgesia for burns dressings,since there is no undue sedation, pre-operative starvation isunnecessary, and venepunctures are avoided. ^*This device is not yet marketed in the United Kingdom. Present address:Department of Anaesthesia, Royal HampshireCountyHospital, Romsey Road,Winchester Present address:Department of Surgery, University of Chicago,Chicago,Illinois 60637     

A SIMPLE METHOD FOR SIMULTANEOUS DETERMINATION OF PLASMA AND RED CELL VOLUME

Several aspects of the methodology and interpretation of dualtracer measurements of blood volume have been investigated.A simple technique using autologous ⁵¹Cr chromated red cellsand ¹²⁵I RIHSA is presented in detail. Accuracy and reproducibilityhave been assessed in duplicate studies in volunteers. Measuredvolumes have been compared with the volumes computed from standardprediction formulae. ^*Present address:Department of Clinical Investigation and Research,DudleyRoad Hospital, Birmingham 18. Present address:Kingston General Hospital, Kingston, Ontario,Canada.     

ADRENALINE INFILTRATION IN VAGINAL SURGERY

Blood loss measurements were carried out on 89 cases of vaginalrepair and 86 cases of vaginal hysterectomy using a haemoglobinextraction dilution technique. Aneasthesia consisted of thiopentone,methoxyflurane, and nitrous oxide with oxygen. The effects onblood loss of infiltrations of adrenaline solution 1 in 1,20,000and 1 2,40,000 were compared with loss when adrenaline infiltrationwas omitte. Results show that either dilution of adrenalinereduced blood loss significantly, but also showed that eitherdilution of adrenaline reduced blood loss significantly. ^*Present addresses:Royal Hospital, Sheffield Present addresses:Oldham General Hospitals     

MASSIVE PULMONARY COLLAPSE DURING THORACOTOMY

A case is described of an incident of acute massive collapseof one lung which was seen to occur in a 28-year-old woman atoperation for mitral valvotomy. The endotracheal tube was satisfactorilyplaced and no abnormality was found on bronchoscopy. The lungslowly expanded during manual inflation with very high pressuresassisted by surgical massage of gas from the re-expanded tothe collapsed lobules. Recovery was uneventful. ^* Nottingham General Hospital, Nottingham. King's College Hospital, London (after January 1, 1967). The Mount Sinai Hospital, New York.     

ANAESTHESIA FOR COMPLETE VAGOTOMY: Postoperative Pulmonary Complications after various types of Gastric Surgery, with special reference to the omission of atropine

An anaesthetic technique is discussed omitting atropine or hyoscinefrom premedi-cation to comply with the requirements of the surgeonperforming complete gastric vagotomy. Experience in sixty casesreveals no evidence of undesirable reflex activity in the cardiovascularsystem, and the increase in secretions in the respiratory tracthas not proved troublesome. The incidence of postoperative pulmonarycomplications is compared with that in a control group usingconventional premedication, and is shown to be lower in thetest group. The relationship of smoking habits, age and sexto postoperative respiratory complications following all formsof gastric surgery is also discussed. ^*Present address: Edinburgh Central Group of Hospitals. Present address: Department of Surgery, University of Aberdeen.     

COMPARISON OF FOUR LOCAL EXTRADURAL ANAESTHETIC SOLUTIONS FOR ELECTIVE CAESAREAN SECTION

We have examined a combination of two local anaesthetics tosee if the resultant solution is superior to the agents individually.This study shows that a mixture of bupivacaine and lignocaineprovided an excellent alternative to bupivacaine alone, andwas superior to 2% lignocaine with adrenaline for elective Caesareansection. By reducing the dose of bupivacaine used, the combinationmay reduce the risk of cardiotoxicity. An account of the preliminary results of this study was presentedat the autumn meeting of the Obstetric Anaesthetists Association,held at the University of Warwick in September 1989. ^*Present address: Charing Cross Hospital, London W6. Present address: Brompton Hospital, London SW3. ^¶Present address: Harefield Hospital, Middx. Present address: Hillington Hospital, Middx.     

DIAZEPAM AND LOCAL ANALGESIA FOR LUMBAR AIR ENCEPHALOGRAPHY

A technique using incremental intravenous injections of diazepamas the sole adjuvant to local analgesia for lumbar air encephalographywas used in twenty-six patients. No clinically significant changesin blood pressure or pulse rate were recorded after the injectionof diazepam and there was no postural hypotension associatedwith the injection of the drug. A dense amnesic action of diazepamis described. Satisfactory conditions were obtained for lumbarair encephalography except in demented patients. Severe dementiais discussed as a possible contraindication to the technique. ^*Present addresses: St. Thomas's Hospital, London S.E.I Present addresses The Hospital for Sick Children, Great OrmondStreet,London W.G1, and St. George's Hospital, London S.W.I.     

VOLTAGE FIELDS SURROUNDING NEEDLES USED IN REGIONAL ANAESTHESIA

Using a bench model, we have studied the voltage fields surroundingboth insulated and uninsulated needles used in regional anaesthesia.The findings were compared with earlier computer predictionswhich suggested that the fields would be markedly differentfor the two types of needle. The results confirm that the fieldsdiffer markedly and suggest that the use of insulated needlesmay not necessarily improve the accuracy of nerve location andthat uninsulated needles may be more appropriate. ^*Present addresses: Department of Anaesthetics, Hull Royal Infirmary,Hull, Humberside. Droitwich Knee Foundation, Saga House, SansomePlace, Worcester Present addresses: Droitwich Knee Foundation, Saga House, SansomePlace, Worcester.     

EFFECTS OF VARYING INSPIRATORY FLOW WAVEFORM AND TIME IN INTERMITTENT POSITIVE PRESSURE VENTILATION I: INTRODUCTION AND METHODS

A general review of the physiological alterations with artificialventilation is presented with particular emphasis on the alterationof inspiratory time and flow waveform. The general methods andphysiological calibration procedures used in a more elaboratestudy of inspiratory time and waveform effects are described,with the results of testing these methods showing that the modelis satisfactory. ^*Present addresses:Department of Anaesthesia, University ofOtago, New Zealand. Present addresses:Princess Margaret Hospital, Swindon, Wilts. Present addresses:St Vincent's Hospital, Melbourne, Australia.     

INTERPLEURAL REGIONAL ANALGESIA: DETECTION OF THE INTERPLEURAL SPACE BY SALINE INFUSION

A saline infusion technique is described for insertion of aninterpleural catheter, to reduce the incidence of pneumothoraxduring conduct of interpleural block, especially if the blockis used as an adjunct to general anaesthesia. Presented in part at the March 1990 meeting, British Section,European Society of Regional Anaesthesia (ESRA).     

SOME PROBLEMS ENCOUNTERED IN A SEVERE CASE OF TETANUS

Tetanus in a 52-year-old woman was managed by muscle paralysisand controlled pulmonary ventilation. Marked peripheral circulatoryfailure developed and was accompanied by a fall in temperatureto subnormal levels (33.3°C) for five days. Paralytic ileusdeveloped also. She was discharged three months after enteringhospital. ^*Present addresses: Crawley Hospital, Sussex Present addresses: St.Thomas's Hospital, London     

DETERMINATION OF THE BLOOD-GAS FACTOR OF THE OXYGEN ELECTRODE USING A NEW TONOMETER

A completely thermostatted bubble tonometer for the determinationof the blood-gas factor of oxygen electrodes is described andits performance evaluated. Equilibration of 3-ml samples ofblood at 37°C with a gas flow of about 100 ml/min takes5 minutes. The blood-gas factor for two oxygen electrode systemshas been determined and some problems in this measurement areoutlined. ^* In receipt of a grant from the Wellcome Trust. In receipt of a grant from the Bayer Products Company.     

MUSCLE PAIN FOLLOWING ADMINISTRATION OF SUXAMETHONIUM: THE AETIOLOGICAL ROLE OF MUSCULAR FITNESS

An attempt was made to correlate the incidence of pain followingthe administration of suxamethonium with muscular fitness andmuscle fasdculations. The overall incidence of pain was 22.1per cent. There was a lower incidence and a lesser severityin patients with greater muscular fitness. No correlation betweenfasciculation and the subsequent development of the muscularcomplications was established. Methods of prevention and theoriesof the aetiology of the pain are discussed. ^* Present address: The United Birmingham Hospitals. Present address: The United Sheffield Hospitals.     

THE EFFECTS OF VARIATIONS IN END-EXPIRATORY INFLATION PRESSURE ON CARDIORESPIRATORY FUNCTION IN NORMO-, HYPO AND HYPERVOLAEMIC DOGS

The effects of altering end-expiratory inflation pressure werestudied in mechanically ventilated dogs in the normo-, hypo-and hypervolaemic state. The mean fall in cardiac output resultingfrom an increase in end-expiratory pressure was smaller in thehypervolaemic group than in the other two groups. A positiveend-expiratory pressure increased the mean deadspace/tidal volumeratio in all groups. A negative end-expiratory pressure increasedvenous admixture, particularly in the over-transfused animals,but the increase was not significant in the hypovolaemic group.A negative end-expiratory pressure did not affect deadspace/tidalvolume ratio. ^*Radcliffe Infirmary, Oxford Western Infirmary, Glasgow St George's Hospital, London Paddington Green Technical College, London     

AN EVALUATION OF GAMMA-HYDROXYBUTYRIC ACID IN PAEDIATRIC PRACTICE

Gamma-hydroxybutyric acid was used as a sedative for 54 childrenundergoing cardiac catherization and as a form of anaesthesiain 159 children undergoing paediatric surgery and various paediatricinvestigations. In 16 of the cardiac group and 22 of the surgicalgroup, an assessment of blood-gas status was made. Clinicalimpressions were favourable and the biochemical findings underlinethe safety, efficacy and usefulness of this drug in paediatricpractice. ^*Department of Cardiology, Newcastle General Hospital, Newcastleupon Tyne. Department of Surgery, The Hospital for Sick Children, GreatOrmond Street, London W.C.I. The Maudsley Hospital, Denmark Hill, London S.E.5.