Low-flow anaesthesia

An 8-week survey was conducted to determine whether the introduction of low-flow anaesthesia (a fresh gas flow of 4 litres/minute or less) into routine use would be acceptable to members of a representative anaesthetic department and if the consequent reduction in use of volatile anaesthetics would result in financial savings. The hourly consumption of the volatile agents was measured during anaesthesia conducted using either conventional or low fresh gas flows. Anaesthetists' acceptance of low-flow anaesthesia was assessed using a questionnaire. Data were gathered on 286 patients undergoing inhalational anaesthesia for routine operative procedures. A 54.7% reduction in the consumption of isoflurane and a 55.9% reduction in that of enflurane was found. Of the 28 anaesthetists at the hospital, 21 would use low-flow anaesthesia routinely. The routine use of low-flow anaesthesia would therefore be acceptable and could result in annual savings of 26,870 pounds at Northwick Park Hospital.     

Beat-to-Beat Variability in Stroke Volume During VVI Pacing as Predictor of Hemodynamic Benefit from DDD Pacing

To determine whether the magnitude of Beat-to-Beat variability in stroke volume (SVJ during VVI pacing can predici hemodynamic benefit from DDD pacing, we undertook Doppier recordings of systolic and diastolic LV flow during VVI and DDD pacing in 20 patients (age 54 ± 9 years)with DDD pacemakers implanted due to AV block. SV increased by 19%± 10% from VVI to DDD (P < 0.01). This increase was greater (29%± 9%)in patients with a ratio of early (E)/late (A) filling < 1 compared to those with E/A > 1 (10%± 9%) (P < 0.001). Beat-to-Beat variability in SV was greater in VVI (13%± 8%)compared to DDD (4%± 1%) (P < 0.001). Patients with E/A < 1 showed greater Beat-to-Beat variability in SV during VVI pacing (19 ± 6%)compared to those with E/A > 1 (8%± 4%) (P < 0.001). Beat-to-Beat variability in SV during VVI pacing correlated with both percent change in SV from VVI to DDD (r = 0.89, P < 0.001)and E/A (r = -0.71, P < 0.001). In conclusion, patients with E/A < 1 derive greater hemodynamic benefit at rest from DDD pacing compared with E/A > 1. In addition, patients with complete AV block who show large variations in SV during VVI pacing may obtain greater hemodynamic benefit at rest from DDD pacing than patients with small variations.     

Nephrectomy for benign disease? A case of isolated renal echinococcosis

Cystic hydatid disease may be found in virtually any organ, although involvement of the urinary tract is relatively uncommon. We report a case of isolated renal hydatid disease presenting with hydatiduria. A short review of the literature regarding diagnosis and management of renal echinococcosis is also presented.     

Modification of the iso-shunt lines for low inspired oxygen concentrations

Arterial Po₂ (Pa_o2) has been related to inspired oxygen concentration(Fl_o2 range 0.21–0.60) in 20 patients, breathing spontaneously,while recovering from a range of conditions treated in an intensivetherapy unit. There was a highly significant linear trend (P< 0.001) for the mean venous admixture ("virtual shunt"),calculated from the iso-shunt diagram (model A), to increasefrom 0.11 to 0.19 as Fl_o2 decreased from 0.60 to 0.21. As thisappeared to be caused by relative ventilation/perfusion (V/Q.)mismatch, we prepared a second model (model B) with a variabletwo-compartment relative V/Q mismatch in addition to a shunt.Regression of the degree of mismatch on the shunt gave goodagreement between predicted and observed Pa_o2 values (mean bias–0.17 kPa, pooled within patient SD 1.22). Model B isnow proposed to extend the applicability of the iso-shunt diagramfor Fl_o2 values less than 0.35. Published postoperative Pa_o2data from other workers showed good agreement with our finalmodel (mean bias 0.10 kPa, pooled SD 0.41). The new diagrammay therefore have wide applicability in the field of anaesthesiaand intensive care. (Br. J. Anaesth. 1994; 72: 515–522)     

Torsade de pointes and long QT syndrome following major blood transfusion

We report a rare complication following transfusion of a large volume of blood in an adult patient. An electrophysiological disturbance of the cardiac cycle with prolongation of the QT interval developed, which was followed by recurrent episodes of torsade de pointes, a unique form of ventricular tachycardia. The most likely cause of this acquired long QT syndrome was hypomagnesaemia secondary to massive blood transfusion. Treatment with a magnesium infusion restored the QT interval to normal and temporary ventricular pacing prevented further ventricular arrhythmias.     

Use of liposuction and saline washout for the treatment of extensive subcutaneous extravasation of corrosive drugs

We report a case of extensive subcutaneous extravasation ofcorrosive drugs used during cardiac resuscitation, in a neonateundergoing cardiac catheterization. Early management with hyaluronicacid, liposuction and saline washout of the extravasated fluidprevented development of any tissue damage. This simple techniquewas easy to use and extremely effective.     

Retroperitoneal seminoma with ''burned out'' phenomenon in the testis

The rare 'burned out' phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor without traces of neoplasm in the testis. This condition is different and less common from the primary extragonadal germ cell malignancies. These malignancies are treated surgically with or without adjuvant chemotherapy or radiotherapy and their prognosis is better than that of other types of primary extragonadal tumors.