The need for and development of a single use disposable nasal spray.

Nasal sprays, which work on the Venturi principle, have the disadvantage of suck-back which makes them unhygienic for use in more than one patient. In Wrexham we have developed a disposable nasal spray system, which is safe and would be of benefit to other ENT departments.

Case report: digital ischaemia following radial artery cannulation.

A case of digital ischaemia following radial artery cannulation is described. The ischaemia developed following three hours hypotension seven days after the radial artery cannula had been removed. Patients with a thrombosed radial artery and a poor ulnar collateral circulation should be identified pre-operatively.

Fibre-optically lit laryngoscope.

The light from a battery-powered laryngoscope with a fibreoptic blade is limited by the 3-V battery and deteriorates with use, as the optic fibres break. A laryngoscope handle is described in which the bulb is replaced by a fibreoptic cable connecting to a mains, halogen light source. This laryngoscope gives 6000 Cd.m(-2) light at the centre of the field compared with 800 Cd.m(-2) for the battery. The field of illumination is also improved from 1600 Cd.m(-2) 20 mm from the centre compared with 120 Cd.m(-2) for the battery handle. The fibre optic cable is attached at the side of the handle and does not interfere with intubation. The mains-powered light source has the advantages of being reliable with the ability to switch immediately to a second bulb; low running costs; improved light for intubation and it makes it possible to use a dental mirror for indirect laryngoscopy in difficult intubations.

Atropine--a safe drug.

Three children received 1000 times the prescribed dose of atropine sulphate and recovered from the main effects of excitatory behaviour and hallucinations in 48 hours. Diazepam was effective in the control of this behaviour. It is suggested that physostigmine should be available where atropine and hyoscine are used or where overdoses are managed.

Acceptability of continuous nasal nitrous oxide during labour--a field trial in six maternity hospitals.

In six maternity hospital 516 mothers during labour received 50% nitrous oxide and 50% oxygen (Entonox) continuously at 5 litres/minute through a single-end nasal catheter and intermittently by a mouthpiece for a mean duration of 3 hours 30 minutes (513 mothers). A comparison was made with a control group of 575 mothers who had intermittent inhalation of Entonox only for a mean duration of 3 hours 6 minutes (574 mothers). The midwives had no difficulty learning to manage the administration of nasal Entonox. Eighty-six per cent of mothers agreed to use the nasal method and 70% continued for the duration of their labour. The midwives reported that pain relief was improved, and 51 (92%) would wish to continue offering the technique.

A safer alternative to the spirit lamp as a mirror warmer in otolaryngology.

The spirit lamp has been used as a mirror warmer in ear, nose and throat departments since the beginning of the speciality. A naked flame is a fire hazard and causes burns. A semi-conductive ceramic heater used for manipulating spectacle frames is a safer alternative.

Self-medication in acute surgical wards.

Self-medication of oral drugs is not current practice on surgical wards. We have introduced a system for suitable patients in which they give to themselves all their oral medication while in hospital. This was introduced in stages to gain the confidence of staff. Many patients wish to self-medicate; this system allows better use of the drugs that they bring into hospital from home; more appropriate timing when in hospital and speed up discharge procedures, as the patient is already familiar with, and has a supply of, their drugs to take home.

Poisoning by cresol.

A man aged 32 years who was poisoned with cresol is reported. It is suggested that in the absence of evidence about haemoperfusion over charcoal, forced diuresis is the only effective means of removing cresols from the body. Artifical ventilation controls early respiratory failure, but the patient remains at risk from toxic damage to the myocardium and lungs.

A study of the brightness of laryngoscope light.

We have measured the brightness (luminance) of the light spot produced by 105 Macintosh 3 laryngoscope blades (33 bulb, 72 fibrelight) using a Hagner photometer. An estimate of the minimum luminance required for laryngoscopy (circa. 100 cd.m-2), was determined using a laryngoscope adapted to provide a variable light output. Five (15%) of bulb blades and 24 (33%) of the fibrelight blades failed to meet this minimum level. A new bulb blade produced brighter lighting conditions (maximum 700 cd.m-2) than a new fibrelight blade (max. 500 cd.m-2). In total, 61 (84%) of the fibrelight blades and three (9%) of the bulb blades were found to provide a light spot that encompassed areas of luminance below 30 cd.m-2, which is a level for comfortable reading. The light spot from a mains-powered fibreoptic bronchoscope was found to be four times brighter (2000 cd.m-2) than a new battery-powered fibrelight laryngoscope.

Comparative study of analgesic efficacy and morphine-sparing effect of intramuscular dexketoprofen trometamol with ketoprofen or placebo after major orthopaedic surgery.

AIMS: Multimodal analgesia is thought to produce balanced and effective postoperative pain control. A combined therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates could result in synergistic analgesia by acting through different mechanisms. Currently there are very few parenterally administered NSAIDs suitable for the immediate postoperative period. Therefore, this study was undertaken to assess the analgesic efficacy, relative potency, and safety of parenteral dexketoprofen trometamol following major orthopaedic surgery. METHODS: One hundred and seventy-two patients elected for prosthetic surgery, were randomized to receive two intramuscular injections (12 hourly) of either dexketoprofen 50 mg, ketoprofen 100 mg or placebo in a double-blind fashion. Postoperatively, the patient's pain was stabilized, then they were connected to a patient- controlled analgesia system (PCA) of morphine for 24 h (1 mg with 5 min lockout). RESULTS: The mean cumulative amount of morphine (CAM) used was of 39 mg in the dexketoprofen group and 45 mg in the ketoprofen group vs 64 mg in the placebo group. (Reduction in morphine use was approximately one-third between the active compounds compared with placebo (adjusted mean difference of -25 mg between dexketoprofen and placebo and -23 mg between ketoprofen and placebo. These differences were statistically significant: P