The CardioPump: CEPOD guidelines and validation of new techniques.
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Cardiopulmonary Resuscitation↗
Biomedical subjects
B T Langham
Publications and source records attributed to B T Langham.
Obstructive sleep apnoea syndrome: is this an overlooked cause of desaturation in the immediate postoperative period?
We report the case of a 38-yr-old man who presented for an emergency mastoidectomy and suffered from severe upper airways obstruction in the postoperative period. Subsequent questioning revealed a history of heroic snoring and further investigations proved a diagnosis of obstructive sleep apnoea.
Adult↗
Anaesthetic implications of aortic stent surgery.
We present a case of abdominal aortic aneurysm repair using a new technique of aortic stenting and discuss the anaesthetic technique used and the perioperative advantages of the technique.
Analgesia↗
Local anaesthesia for cannulation. Has practice changed?
A questionnaire study was undertaken to assess the influence of recently published, simple and conclusive research on the practice of anaesthetists in four centres. The research had clearly demonstrated the benefit of subcutaneous infiltration of local anaesthetic in reducing the pain of intravenous cannulation. Of the 81% who responded, 71% were aware of the research; 43% of these anaesthetists had altered their clinical practice as a result of the research and 73% used local anaesthesia for cannulae of 18 gauge or less, compared with only 46% of those who were unaware of the research. Practice comparisons were made between centres and grades of anaesthetist. Senior house officers were significantly less likely to be aware of the research than other grades. Anomalies were identified between the apparent awareness of the research and routine practice agreeing with the study findings. The value of research and the incorporation of clinical findings into everyday practice is discussed.
Anesthesia Department, Hospital↗
Severe airway management problems during insertion of a cuffed oesophageal stent.
A 68-year-old man underwent a general anaesthetic for insertion of an oesophageal stent for a tracheo-oesophageal fistula. The authors report the management of severe airway problems caused by the insertion of the stent and discuss the use of a double lumen tube in this situation.
Aged↗
Post-dural puncture headache: a comparison of the Sprotte and Yale needles in urological surgery.
One hundred elderly male patients undergoing transurethral surgery were allocated randomly to receive spinal anaesthesia with either a 26 gauge Yale needle or a 24 gauge Sprotte needle. Patients were visited within 48 h by an investigator who was unaware of the needle type used and specific enquiry was made about any headache which was characteristic of dural puncture. We found evidence of a postdural puncture headache in 15 (30%) patients in whom a 26 gauge Yale needle was used. By comparison, only three patients (6%) in the Sprotte group reported a postdural puncture headache. This represents a highly significant (P < 0.005) reduction in the incidence of postdural puncture headache. The incidence of multiple attempts at dural puncture was also significantly (P < 0.05) reduced to 16% in the Sprotte group compared with 28% in the Yale group.
Aged↗
The pressor response to venous cannulation: attenuation by prior infiltration with local anaesthetic.
We have compared the cardiovascular response to insertion of an 18-gauge venous cannula in 40 healthy patients. In 20 of the patients, cannulation was preceded by infiltration of local anaesthetic. Both rate-pressure product and mean arterial pressure increased significantly (P < 0.01) compared with baseline when no local infiltration was used, but there was no significant change from baseline when infiltration with local anaesthetic preceded cannulation. We conclude that there is a significant pressor response to venous cannulation which is obtunded by prior infiltration with local anaesthetic. We recommend, therefore, that s.c. injection of lignocaine should be considered before insertion of an i.v. cannula, especially in the high risk patient.
Adolescent↗
Appropriate use of local anaesthetic for venous cannulation.
A departmental survey indicated that the large majority of anaesthetists believed that injection of local anaesthetic before insertion of an intravenous cannula was unnecessary if a cannula of 18 gauge or smaller was used, because injection of local anaesthetic would be more painful than insertion of the cannula. A study was undertaken to test this hypothesis. The results showed that intravenous cannulation with a cannula of 18, 20 or 22 gauge was significantly (p less than 0.006) more painful than a subcutaneous injection of 1% lignocaine. We recommend that subcutaneous injection of local anaesthetic should be considered before insertion of any size of intravenous cannula.
Adult↗
Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula?
A recent study performed in this department showed that a subcutaneous injection of local anaesthetic was significantly less painful than the insertion of a 22-gauge venous cannula. However, our colleagues remained sceptical that local anaesthetic infiltration would eliminate the pain of cannulation. Consequently a further study was undertaken to compare the pain of cannulation with and without the use of local anaesthetic. The results show that pain of cannulation is significantly (p < 0.003) reduced after subcutaneous infiltration with 1% lignocaine when compared to cannulation without local infiltration. Persistent discomfort at the site of cannulation was eliminated by the use of local anaesthetic.
Adult↗
Spinal anaesthesia for urological surgery. A survey of failure rate, postdural puncture headache and patient satisfaction.
A survey was conducted on 100 consecutive patients who underwent spinal anaesthesia in our urology operating theatres. Details of the spinal technique were recorded in the operating theatre. In 25% of patients, more than one attempt at subarachnoid puncture was required and 16% of this group went on to require general anaesthesia. The patients were visited between 24 and 48 h postoperatively by one of the authors. On questioning, 24% of patients reported a headache, which had the characteristics associated with dural puncture; 62% of these headaches were described as moderate or severe and lasted between 12 and 24 h. Patients were significantly (p < 0.05) more likely to develop a postdural puncture headache if more than one attempt at subarachnoid puncture was made.
Aged↗