Environmental contamination during tracheal suction

The extent of airborne environmental bacterial contamination which occurs following tracheal suction has been investigated in patients undergoing intermittent positive pressure ventilation in the intensive therapy unit. Two methods of performing suction, one using a conventional open technique and one using a closed system (Stericath), have been compared. Significantly lower levels of environmental contamination were observed when the closed system was used.     

Oropharyngeal volumes

The volume of the mouth and pharynx was measured in 20 cadavers and ranged from 25 to 202 ml with a median value of 87 ml, a mean of 90.7 ml and a geometric (logarithmic) mean of 78.3 ml. The volume that encompasses 99% of the normal population is estimated as 215 ml if the assumption of a normal Gaussian distribution is made, or 342 ml [corrected] if a log-normal distribution is assumed. Collection containers in suction equipment intended for removing vomit from the pharynx and mouth in adults should have a useable volume of at least 500 ml.     

A simple device for controlling suction force in neurosurgical operations

A simple and inexpensive device for controlling suction force in neurosurgical operations is described. This device is interposed in the suction tubing on the sterile surgical field. This has the advantage of allowing the surgeon to alter the suction force quickly and easily, according to his or her preference. The total cost is minimal, and the device may be assembled with supplies currently available in most operating rooms.     

自制简易负压吸引装置在创面修复术前的应用

目的:探讨自制简易负压吸引装置在创面修复术前期准备中的治疗作用。方法:对27例有皮肤软组织缺损的患者采用自制的简易负压吸引装置治疗,并在每次更换负压装置时进行清创。经过7～30日,平均15.6日的治疗后,在创面上行二期游离植皮或皮瓣转移修复术。结果:27例患者经过治疗后创面清洁,面积较前缩小,肉芽生长新鲜,游离植皮或皮瓣转移修复均一次性获得成功。结论:自制简易负压吸引结合间断清创能够减少创面污染,促进肉芽组织生长,促进创面的愈合,为二期手术创造条件,缩短术前准备时间,且减轻医务人员换药工作量,减轻患者痛苦。     

A novel device for reducing hemolysis provoked by cardiotomy suction during open heart cardiopulmonary bypass surgery: a randomized prospective study

Since the inception of cardiopulmonary bypass (CPB), little progress has been made concerning the design of cardiotomy suction (CS). Because this is a major source of hemolysis, we decided to test a novel device (Smartsuction [SS]) specifically aimed at minimizing hemolysis during CPB in a clinical setting. Block randomization was carried out on a treated group (SS, n=28) and a control group (CTRL, n=26). Biochemical parameters were taken pre-, peri-, and post CPB and were compared between the two groups using the Student's t-test with statistical significance when P<0.05. No significant differences in patient demographics were observed between the two groups. Lactate dehydrogenase (LDH) and plasma free hemoglobin (PFH) pre-CPB were comparable for the CTRL and SS groups, respectively. LDH peri-CPB was 275+/-100 U/L versus 207+/-83 U/L for the CTRL and SS groups, respectively (P<0.05). PFH was 486+/-204 mg/L versus 351+/-176 mg/L for the CTRL and SS groups, respectively (P<0.05). LDH post CPB was 354+/-116 U/L versus 275+/-89 U/L for the CTRL and SS groups, respectively (P<0.05). PFH was 549+/-271 mg/L versus 460+/-254 mg/L for the CTRL and SS groups, respectively (P<0.05). Preoperative hematocrit (Hct) of 43+/-5% (CTRL) versus 37+/-5% (SS), and hemoglobin (Hb) of 141+/-16 g/L (CTRL) versus 122+/-17 g/L (SS) were significantly lower in the SS group. However, when normalized (N), the SS was capable of conserving Hct, Hb, and erythrocyte count perioperatively. Erythrocytes (N) were 59+/-5% (CTRL) versus 67+/-9% (SS); Hct (N) was 59+/-6% (CTRL) versus 68+/-9% (SS), and Hb (N) was 61+/-6% (CTRL) versus 70+/-10% (SS) (all P<0.05). This novel SS device evokes significantly lowered blood PFH and LDH values peri- and post CPB compared with the CTRL blood using a CS system. The SS may be a valuable alternative compared to traditional CS techniques.     

A disposable device for infusion analgesia

The performance of the Travenol infusor when used to administer an intravenous infusion of analgesic after surgery has been investigated. Mean flow was very similar to the manufacturer's quoted figure of 2 ml/hour, but there was a large interindividual variation. Results from a laboratory study suggest that this was due to variation in the manufacture of the infusor.     

简易持续负压吸引在深度创面的应用观察及护理

目的：探讨简易持续负压吸引对促进深度创面愈合的疗效及护理。方法：50例患者分为治疗组25例和对照组25例,对照组给予常规换药,治疗组用简易材料进行持续负压吸引,比较两组的换药次数、应用抗生素费用及总住院时间等指标,评估疗效。结果：在换药次数、应用抗生素费用及总住院时间等,治疗组均优于对照组。结论：简易负压吸引是一种良好的促进深度创面愈合的方法,配合创面观察及护理,疗效优于传统方法,值得推广。     

The Engström Elsa anaesthetic machine An electronic system for anaesthesia

Six Engstr?m Elsa anaesthetic machines have been in regular use for 18-24 months. The machine incorporates a number of new concepts for anaesthetic delivery and monitoring. At flows below 1000 ml/minute, each machine delivered 20% more than the indicated value; at higher flows, the indicated value was within 10% of the flow delivered. Minute volume, tidal volumes and oxygen concentrations were within the manufacturer's specifications. However, vaporizer and vapour monitor performance was outside the (SD) 5% accuracy claimed by the manufacturers. It was noted that the bistable valve requires user familiarity for the change from controlled to spontaneous ventilation to be accomplished with ease. It was also possible to misconnect the breathing system and so isolate the excess pressure escape valve and high-pressure alarm. Nevertheless, once familiarisation was achieved, the machines have proved easy to operate and are particularly satisfactory when used with low fresh gas flows.     

The Ohmeda Excel anaesthetic machine

The Ohmeda Excel 410 anaesthetic machine is described. A report of its use on 100 patients and impressions of its innovations are given.     

A new type of prehensile suction device

The authors describe a new suction device with prehensile properties that has proved itself particularly useful in the removal of certain types of tumor, especially extramedullary.     

Anaesthetic machine checking practices

Forty anaesthetists, of all grades, were interviewed without prior warning and questioned about the checks they had performed on their anaesthetic equipment before use. The results reveal that a substantial percentage (up to 41%) of anaesthetists perform inadequate checks. Furthermore, of those that do, few follow the Association of Anaesthetists of Great Britain and Ireland's recent guidelines.     

Efficient atraumatic liquid suction by means of slit suction tubes combined with a pressure control unit

Summary In 1976 a modified suction system for neurosurgery and precision surgery was presented. It was developed to meet the need for efficient and atraumatic liquid suction. The system consists of suction tube ends provided with three vertical slits in the suction edge (W-tubes), a Pressure Control Unit (PCU) and an independent suction pump with an air capacity of 25–30 litres per min. This system has subsequently been modified for microsurgery. The PCU normally controls the negative pressure to 20 kPa (corresponding to 200 cm of water) for atraumatic suction of liquid, which is needed during most of the operating time. For suction of various tissues or cleaning the system, the surgeon can set the pressure limit to 50 or 90 kPa by means of a foot-operated IR-transmitter in a pedal with a kick-down function. The PCU and the W-tubes, which neutralize the pressure load on tissue and the sudden interruption of liquid flow that are inevitable with conventional suction tips, form a system with a high liquid suction capacity in spite of the atraumatic suction pressure. This is possible because the slits maintain a large active suction area. Crushed or soft tissues and coagulated blood are aspirated as and when required, if necessary by elevation of the negative pressure limit. The W-tubes are not provided with an air inlet hole on the tube because that method of pressure control proved unpredictable and variable and reduced the suction capacity by interfering with the flow. The system permits continuous efficient and safe suction of liquid in contact with nervous tissue and hence provides a good range of vision in the operation field even in cases of extensive haemorrhage (> 500 ml of blood per min). The system forms a good complement to ultrasonic aspiration, which is mainly intended for atraumatic tissue elimination.