Flexible fiberoptic endoscopy in difficult intubations.

Intubation problems sometimes occur very suddenly and can be divided into two groups. The expected ones include the patients with a short neck and long teeth, cellulitis of the tongue, large oropharyngeal tumors, obstructing laryngeal tumors, congenital and acquired maxillofacial deformities, ankylosis of the temporomandibular joints, fractures or ankylosing spondylitis of the cervical spine, and all patients with a history of previous intubation problems. Unexpected problems can arise in patients who combine large incisors and canines with an inability to open the mouth wide, or when the glottis is invisible because the epiglottis is immobile. The first concern in these cases is to restore consciousness, for the conscious patient shows tonus and this facilitates identification of anatomical landmarks. A 60 cm bronchofiberscope provided with a tube and a freely movable end of 30 cm is suitable. Shorter flexible scopes are not adequate.

Effects of the analeptic drug, 4-aminopyridine, upon post-operative respiratory depression in patients. A preliminary study.

The analeptic agent, 4-aminopyridine, was given to patients who had undergone elective ear, nose and throat surgery and showed severe central respiratory depression due to intra-operative fentanyl administration. The respiratory depression due to fentanyl was found to be partially antagonised by 4-aminopyridine. In view of these preliminary findings it is suggested that the drug might find a use in combatting postoperative fentanyl-induced respiratory depression.

4-Aminopyridine reversal of fentanyl-induced respiratory depression in normocapnic and hypercapnic patients.

Profound postoperative respiratory depression after larger doses of fentanyl was partially reversed by 4-aminopyridine. This reversal was independent of FIO2' suggesting that the response was not dependent upon peripheral chemoreceptor-mediated drive. Similar reversal of fentanyl-induced depression by 4-aminopyridine was observed before surgery in patients breathing 67% nitrous oxide in oxygen. 4-Aminopyridine had no effect on breathing when given alone in the absence of fentanyl to patients breathing 67% nitrous oxide in oxygen before surgery.

Thumb paraesthesia after neuromuscular twitch monitoring.

Nine patients, who had operations for ear and nose pathology and developed left thumb paraesthesia after neuromuscular twitch monitoring with the Gould Statham UC3 force displacement transducer are described. The pathophysiology and prevention of the complication is discussed.

Three years' anaesthetic experience with the Groningen Nd YAG laser coagulation technique.

The use of the Neodymium YAG Laser technique in the palliative treatment of tracheo-bronchial tumors in 47 patients is described and the merits of the coagulation and anaesthetic techniques are discussed.

Continuous intravenous anesthesia with etomidate for carbon dioxide laser surgery of the larynx.

Twenty-five adult patients undergoing carbon dioxide laser surgery for benign and malignant disease of the larynx were given continuous infusion of etomidate at 60 micrograms . kg-1 . min-1 for induction of anesthesia. Maintenance anesthesia was continued using one of three infusion rates: 20 micrograms . kg-1 . min-1 (n = 5), 30 micrograms . kg-1 . min-1 (n = 10), and 40 micrograms . kg-1 . min-1 (n = 10) of etomidate in air-oxygen mixture. Muscular relaxation was achieved by continuous infusion of succinylcholine, and fentanyl was used for analgesia. Continuous etomidate infusion for induction of anesthesia resulted in a significant decrease in the incidence of pain along the injection site to 8% and involuntary muscular movements to 12% compared with 35% and 44%, respectively, in a group of 25 adult patients undergoing endoscopic procedure who received intravenously a single volus injection of etomidate (0.3 mg .g kg-1). However, a prolonged recovery time was observed after 30 minutes of continuous etomidate infusion.

An electroencephalographic study of 4-aminopyridine.

The electroencephalographic (EEG) effects of 4-aminopyridine (4-AP) given intravenously in therapeutic doses were studied in four conscious human volunteers. 4-AP (0.2 mg/kg) caused an increase of the occipital alpha peak frequency of 0.4 to 1.0 Hz. In the dose range of 0.2 to 0.3 mg/kg there was neither evidence for epileptic activity in the EEG nor were any clinical side effects observed. This dose of 4-AP was also found to antagonize diazepam-induced sleep in four volunteers. In addition 4-AP (0.3 mg/kg) hastened the recovery by a factor of 4 in four patients having endoscopic procedures under diazepam-nitrous oxide anesthesia.

Effect of chlorhexidine 0.5% on the hand bacterial flora.

The effects of cleaning the dorsal hand with chlorhexidine 0.5% in spirit was evaluated by bacteriological study in 45 adult patients. In the absence of cleaning it was found that the prevalent microorganisms were Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus viridans and Enterobacteriaceae. Cleaning the hand with chlorhexidine 0.5% eliminated all bacteria except S. epidermidis and S. aureus. In both instances, the culture results showed that the microorganisms were present in very low growth density.