The laryngeal mask airway facilitates intubation at cesarean section. A case report of difficult intubation.

Failed intubation at cesarean section presents the anesthesiologist with a challenge, and may subject both mother and baby to significant morbidity and in some cases, mortality. We report a case of failed intubation at an emergency cesarean section at which intubation was subsequently achieved using a laryngeal mask airway as a guide.

Fluid absorption during laser ablation of the endometrium in the treatment of menorrhagia.

Twenty-six women participated in a two-part study to determine the magnitude of absorption of irrigating fluid during endometrial laser ablation (ELA), and the effect on this absorption of controlling the intra-uterine pressure (IUP) during ablation. Six women participated in the first part of the study in which IUP was uncontrolled during surgery. The mean fluid deficit was 2027 ml. In the second part of the study, 20 women were allocated randomly to two groups. In the first group (nine women), IUP was uncontrolled during surgery. The mean IUP was 100 mm Hg, mean maximum IUP 136 mm Hg and mean fluid deficit 1255 ml. In the second group (11 women), the IUP was controlled during surgery. The mean IUP was 66 mm Hg, mean maximum IUP 70 mm Hg, and there was no fluid deficit in any of the women. The study demonstrates that control of IUP during ELA was effective in preventing absorption of irrigating fluid.

Actions of salbutamol, disodium cromoglycate, and placebo administered as aerosols in acute asthma.

The effects on the peak expiratory flow rate of the drug sequences, placebo-salbutamol-disodium cromoglycate and placebo-disodium cromoglycate-salbutamol administered via a nebuliser were examined in 35 children with asthma. Twenty children were each examined once within 4 hours of admission to hospital with an acute attack of asthma, and the remaining 15 children were examined later in the attack on two occasions. The placebo effect of sterile water accounted for about half of the total bronchodilator action both early and late in the attack. It is suggested that this effect is due to the action of water on the surface film of surfactant, causing collapse of bubbles and strands or webs of mucoid material, thus decreasing airways resistance. At this time salbutamol is significantly more potent than disodium cromoglycate as a bronchodilator agent.

Mechanical inefficiency of the thoracic cage in scoliosis.

The mechanism of impairment of ventilatory function in idiopathic scoliosis has been studied in 23 children, all girls, and compared with 27 normal children and 24 normal young adult females. The vital capacity, FEV 1, gas transfer factor, and the maximum static expiratory airway pressure were all significantly reduced. total lung capacity and the maximum inspiratory pressure were lower than in the normal subjects, but the difference was not significant. Restriction of thoracic cage movement by a belt showed that the thorax in the children with scoliosis was as mobile as in the normal subjects. The results are explained in terms of the characteristic deformity in scoliosis which causes one hemi-thorax to become relatively smaller than the other. It is concluded that this causes an inherent mechanical inefficiency of ventilation which is likely to contribute to respiratory failure in these subjects.