Combined high-frequency ventilation (CHFV) in the treatment of acute lung injury--a case report.

A 22-year-old man was admitted to a district general hospital with chest injuries, a ruptured spleen and limb fractures, sustained in a road traffic accident. After an emergency splenectomy, the patient developed unilateral pulmonary oedema with hypoxaemia which was resistant to both conventional controlled mechanical ventilation (CMV) and independent lung ventilation (ILV). He was transferred to a specialist cardiothoracic unit where high frequency jet ventilation (HFJV) also failed to achieve adequate oxygenation. Combined high frequency ventilation (CHFV), using high frequency pulses from a Bromsgrove Penlon Jet ventilator superimposed onto small tidal volumes from an Engstrom Erica improved oxygenation rapidly to allow decreases in inspired oxygen fraction (FiO2), peak airway pressure (PAWP) and positive end expiratory pressure (PEEP). Progressive weaning from ventilatory support was then possible over five days. CHFV is a valuable technique in the treatment of acute catastrophic lung injury and needs wider recognition.

Dose of propofol required to insert the laryngeal mask airway in children.

We have assessed the ease of insertion of the Brain Laryngeal Mask Airway (LMA) after induction of anaesthesia with propofol in 60 healthy unpremedicated children aged between four and nine years. Patients were randomly allocated into three groups: group A = propofol 2.5 mg.kg-1; group B = propofol 3 mg.kg-1 and group C = propofol 3.5 mg.kg-1. Propofol was mixed with lignocaine 0.5 mg.kg-1. Insertion conditions were assessed subjectively as good, acceptable, unacceptable or impossible. Insertion of the LMA was possible in all patients. Good and acceptable conditions were obtained in 35%, 70% and 95% in groups A, B, and C respectively (P < 0.0001). There was no statistically significant inter group variation in systolic and diastolic arterial pressure or in heart rate for five min after induction. All measured cardiovascular changes were considered to be clinically insignificant in healthy children. We conclude it is safe and effective to insert a LMA immediately after induction of anaesthesia with propofol 3.5 mg.kg-1.

Comparison of the haemodynamic effects of dobutamine with enoximone after open heart surgery in small children.

We have studied 28 children (mean age 13.6 months) undergoing elective cardiac surgery involving a myocardial ischaemic time greater than 60 min. Thirteen received phenoxybenzamine 1 mg kg-1 before cardiopulmonary bypass (CPB) and dobutamine 10 micrograms kg-1 min-1 before discontinuation of CPB; 15 received enoximone 0.5 mg kg-1 followed by an infusion of 10 micrograms kg-1 min-1 before discontinuation of CPB. Haemodynamic variables were measured at intervals for 6 h after CPB. Two patients in each group required additional inotropic support with adrenaline. Heart rates, right and left atrial pressures, mean pulmonary artery pressures and systemic and pulmonary vascular resistance indices were similar in the two groups. Mean arterial pressure was significantly greater in those receiving dobutamine (61.3 (SD 7.6) mm Hg) compared with enoximone (56.2 (5.3) mm Hg) (P < 0.05). Differences in cardiac index (thermodilution) (dobutamine group 2.92 (0.62) litre min-1 m-2; enoximone group 2.55 (0.55) litre min-1 m-2) and left ventricular stroke work index (dobutamine group 13.1 (4.7) g m beat-1 m-2; enoximone group 10.4 (2.7) g m beat-1 m-2) were not statistically significant. Enoximone may be used successfully in these patients to assist discontinuation of CPB and maintain an acceptable haemodynamic state in the early postoperative period but, when used alone, conferred no advantage compared with the combination of dobutamine and phenoxybenzamine.