Pulmonary resection in the prone position for suppurative lung disease in children.

Lung resection for suppurative inflammatory disease is hazardous in children whose small airway diameter precludes the use of standard methods of bronchial separation. A prospective evaluation of the prone position for thoracotomy in 17 children referred for operation with severe inflammatory disease was done. Bronchography showed whole lung bronchiectasis eight, destroyed lung in three, and lobar bronchiectasis five. Pulmonary resections performed with the child prone included left pneumonectomy (nine), right pneumonectomy (four), lingulectomy with lower lobectomy (two), and other lobectomy (two). No endobronchial or intrapleural spillage occurred. One child required reexploration for bleeding and one child developed a postoperative empyema that ultimately caused death. The remaining 16 children were discharged within 8 days of operation, and follow-up of 1 to 18 months records favorable progress.

Tension pneumoperitoneum aggravating respiratory failure. A case report.

A case of tension pneumoperitoneum secondary to barotrauma is reported. Any patient needing high pressures for ventilation and oxygenation is prone to this complication. The important respiratory and haemodynamic implications are discussed. It is suggested that drainage of a tension pneumoperitoneum is easy and safe and has major beneficial effects on the respiratory and cardiovascular systems.

The response of animals to suxamethonium (succinyldicholine) and succinylmonocholine.

The time which elapses before cessation of breathing, and blood pressure and blood gas changes after the intramuscular administration of suxamethonium, or a mixture of suxamethonium and hexamethonium, is compared in immobilised African elephants (Loxodonta africana) and buffaloes (Syncerus caffer). In addition, the respiratory responses of elephants and other animals to intravenous administration of suxamethonium and succinylmonocholine are reported on, as are the effects of darting animals with succinylmonocholine. The results show that respiration is affected in a similar fashion in all species investigated. However, the characteristic gradual decrease in respiratory rate seen in elephants during culling, using suxamethonium, resembles the effects observed when succinylmonocholine is administered. It is suggested that elephants are killed by this first breakdown product of suxamethonium during culling and/or that unique acetylcholine receptors may be involved.

Blood constituent responses of animals culled with succinyldicholine and hexamethonium.

Blood constituent responses of elephants and buffaloes culled in the Kruger National Park, using a mixture of succinyldicholine and hexamethonium, were compared to those of animals culled with succinyldicholine only. The results show a decreased physiological response in the animals culled with the mixture, characterised by lower total catecholamine, cortisol and glucose concentrations. Neither a delay of up to 30 min in obtaining blood samples from culled animals, nor a delay of up to 30 min in processing samples obtained immediately after cessation of respiration, gave any significant difference in the blood constituents which were measured.

Hypokalaemia after suxamethonium administration.

The effect of suxamethonium on serum potassium levels was studied in 20 black patients undergoing emergency surgery. All patients were resuscitated pre-operatively to achieve a normal pH (range 7.35-7.45), normal electrolyte values (potassium range 3.5-4.5 mmol/l), and an adequate circulating blood volume using the criteria of systolic blood pressure in excess of 100 mmHg and a central venous pressure maintained at more than 2 cm H2O. Suxamethonium (approximately 0.8 mg/kg) was administered during a standard rapid intubation sequence for the induction of anaesthesia. In the adequately resuscitated emergency patient an induced respiratory alkalosis may prevent the rise in serum potassium previously reported with the use of suxamethonium.

Valveless anaesthetic circuits incorporating scavenging.

A new principle is described which eliminates the need for expiratory valves in anaesthetic circuits. Scavenging of waste anaesthetic gases is also achieved. The innovations are simple, allow easy cleaning and sterilization, and can be regarded as disposable if necessary. The advantages of low circuit pressure and ease of operation are described.

Rapid tracheal intubation with propofol, alfentanil and a standard dose of vecuronium.

We studied 60 ASA I patients with Mallampati grade 1 airways to compare emergency intubating conditions with either alfentanil 20 micrograms kg-1, propofol 2.5 mg kg-1 and vecuronium 0.1 mg kg-1, or with thiopentone 5 mg kg-1 and suxamethonium 1 mg kg-1. Ease of laryngoscopy, vocal cord status and cough response were graded. The trachea of all patients was intubated; 83% of patients in the alfentanil-propofol-vecuronium group and 86% in the thiopentone-suxamethonium group were considered to have satisfactory intubating conditions at 60 s. We conclude that the combination of alfentanil 20 micrograms kg-1, propofol 2.5 mg kg-1 and vecuronium 0.1 mg kg-1 provided adequate conditions for rapid tracheal intubation.

The respiratory effects of tilidine hydrochloride.

A standard 50-mg dose of tilidine hydrochloride (Valoron) was administered to 20 patients in the postoperative phase of open-heart surgery. No significant change in respiratory status, as measured by arterial blood gas analysis, was demonstrated with this dosage.

Evaluation of a scavenging device for use with automatic ventilators.

A T-piece designed for use with either high- or low-pressure extraction systems is described, which appears suitable for use with automatic ventilators. A simple method of estimating suction flow, based on the time required to empty 1 I water, is described.

An evaluation of the Samson and Magill (Mapleson A) circuits during anaesthesia.

The valveless scavenging circuit of Samson was compared with a standard Magill (Mapleson A) circuit. Replacement of the scavenging unit of the Samson circuit by the Heidbrink valve of the Magill circuit at a given fresh gas flow rate allowed each patient to act as his own control. The minimum and maximum carbon dioxide levels were estimated at varying fresh gas flows related to the body weight of the patient. The carbon dioxide elimination of the two circuits showed no statistical difference and it is concluded that the Samson circuit requires fresh gas flows similar to the Magill circuit. The Samson circuit scavenged adequately during spontaneous breathing, manual ventilation and even when using the emergency oxygen bypass.

Anaesthetic breathing circuit obstruction due to blockage of tracheal tube connector by a foreign body--two cases.

Two cases are presented which illustrate the disastrous consequences possible when an anaesthetic breathing circuit is obstructed by a foreign body. Despite reports of previous similar cases, work practices and equipment manufacture or design continue to allow for such events to occur. The importance of both pre-anaesthetic testing of the entire circuit including attachments such as the tracheal tube connector and filters, and the removal of these parts should obstruction occur, is emphasised. Use of "clear" transparent breathing circuit components and opaque or brightly coloured packaging and caps which could potentially cause obstruction should decrease the incidence and facilitate the diagnosis of this problem.

Ventilation monitors and alarms.

In this review we present a proposed classification of the various types of ventilation monitors and failure alarms used in anaesthetic practice. Each monitoring method is then discussed individually and the advantages and disadvantages are evaluated.

The use of the Samson modification of the Mapleson 'A' circuit during blind nasal intubation for anaesthesia.

A technique of blind nasal intubation for anaesthesia using the Samson modification of the Mapleson 'A' circuit is described. Adequate depth of anaesthesia is maintained by continuous insufflation, and scavenging is continuously used to remove waste anaesthetic gases. The position of the tube in relation to the larynx is estimated by movement of the reservoir bag and intermittent condensation of expired water vapour in the clear plastic of the circuit.

Anaphylaxis due to suxamethonium? A case report.

A case of profound cardiovascular collapse after the administration of Althesin (alphaxalone-alphadolone) and suxamethonium is described. During subsequent anaesthesia in the same patient, cardiovascular collapse followed the administration of thiopentone and suxamethonium. It is concluded that suxamethonium, rather than Althesin, was the provocative agent.

Pulmonary aspergilloma--indications for surgical intervention. An analysis of 22 cases.

Surgical resection of aspergillomas has generally been associated with excess mortality and morbidity; 22 patients who had a resection of complicated mycetomas were studied retrospectively. Indications for surgery were serious haemoptysis (14), massive haemoptysis (6), and recurrent infection (2). Extrapleural pneumonectomy was required in 9 patients and extrapleural lobectomy in 12; thoracoplasty alone was done in 1 patient. There was 1 hospital death (4.5%); 4 patients developed postoperative empyemas (18%), 2 with associated bronchopleural fistulas. Two further patients (9%) had stable postresectional spaces. Surgery for complicated aspergilloma was associated with significant postoperative morbidity.

Etomidate infusion for resection of phaeochromocytoma. A report of 2 cases.

Anaesthesia in patients undergoing resection of phaeochromocytomas is associated with fluctuations in blood pressure and cardiac dysrhythmias. Two patients in whom an etomidate (Hypnomidate; Janssen Pharmaceutica) infusion was used as a supplement to droperidol, fentanyl, pancuronium, air and oxygen anaesthesia are described. Cardiovascular stability was well maintained; the advantages of this technique are discussed.

Clinical effects of nitrous oxide and oxygen mixtures at sea-level and at 1700 metres altitude.

The effects of nitrous oxide, at sea-level and at an altitude of 1700 m, were assessed on a subjective and objective basis. Only marginal differences were shown between the effects of the gas at sea-level and 1700 m. Since consciousness was impaired with 60 and 70% nitrous oxide it is suggested that the use of Entonox-oxygen mixtures should be considered for single-handed operators.

A comparison between meptazinol and omnopon in the relief of postoperative pain.

In a random double-blind trial, meptazinol 100 mg, a new hexahydro-azepine derivative, was found to be comparable to Omnopon (papaveretum) 20 mg when given intramuscularly for the control of pain in 50 cases after hysterectomy. The onset of analgesia was rapid and the effect lasted for about 3 hours. Cardiovascular and respiratory systems remained stable. No significant difference as regards sedation and nausea was noticed between the two groups.