Difficult diagnostic laryngoscopy and bronchoscopy aided by the laryngeal mask airway

A case of difficult diagnostic rigid bronchoscopy is described. However, flexible fibrescopy could be easily performed through a laryngeal mask airway despite complete lack of experience by the operator. Excellent visualization of the larynx and bronchial tree with minimal haemodynamic disturbance accompanied the technique.

Effect of indomethacin on the pharmacokinetics of methotrexate in rabbits

The interaction between indomethacin (IND) and methotrexate (MTX) was investigated in rabbits. The study was designed so as to evaluate the effect of IND (1 mg h-1) during a continuous MTX infusion (1 x 2 mg kg-1) over 240 min. IND was injected i.v. at hourly intervals after a steady state MTX concentration had been established. Plasma MTX concentration before and after IND did not differ significantly (p greater than 0.05). The elimination half-life (t1/2 beta) calculated during the washout interval (mean +/- SD) was 47 x 4 +/- 21 x 5 min which is close to that calculated in a reference group of rabbits. This excludes the possibility of delayed elimination as responsible for this toxicity. The toxicity of this combination was confirmed despite the absence of significant pharmacokinetic changes. It is possible that the toxic interaction was caused by enhanced cytotoxic effect of MTX.

Peri-anesthetic management of tracheo-esophageal fistula

During a 3-year period 11 neonates underwent general anesthesia for primary repair of tracheo-esophageal fistula (TEF). The age ranged from 1-10 days. Out of these patients, 8 (72.7%) had atresia of the esophagus with a blind upper pouch and lower segment communicating with a trachea. A total of 7 patients (63.6%) had aspiration pneumonitis pre-operatively. Intubation was difficult in 3 (27.3%). There was no intraoperative mortality. However, the incidence of post-operative mortality was 27.3% (3 cases). The cause of death in all these cases was severe non-resolving pneumonia.

Intraoperative myocardial ischaemia in surgical patients with treated ischaemic heart disease

Twenty patients were divided into 2 groups. Group - A had 10 ASA Grade I while Group - B consisted of 10 asymptomatic patients with ECG evidence of ischaemia. One week of coronary dilator treatment was given to the patients in group-B before surgery. Intra operative cardioscopic monitoring was done in both the groups. In group-B, 5 patients showed ECG evidence of intraoperative myocardial ischaemia, and/or ventricular ectopics, which were in most cases attributable to anaesthetic/surgical stimuli but were not always associated with increased Rate pressure product. In group-A only one patient showed ECG evidence of ischaemia intraoperatively. It is therefore concluded that patients with optimal therapy for IHD continue to be at risk of intraoperative cardiovascular abnormalities.

Verapamil as a hypotensive agent under general anaesthesia

Thirty-six adult female patients undergoing abdominal hysterectomy under general anaesthesia were evaluated for the haemodynamic effects of IV verapamil in bolus dose of either 50 micrograms/kg (group A), 60 micrograms/kg (group B) or 75 micrograms/kg (group C). The result showed a dose dependent fall in the mean arterial pressure and increase in the P-R interval. The fall in heart rate was marginally more in group A and B as compared to group C.

Tracheal extubation under intravenous xylocaine

The quality of extubation and circulatory changes during extubation of the trachea with or without prior xylocaine (1 mg/kg iv) were observed in 30 patients having CAD or 2 or more cardiac risk factors. 73.33 per cent of the patients receiving xylocaine had smooth extubation (grade I) in contrast to only 46.66 per cent in the control group. Also, in patients in the xylocaine group, the circulatory changes were statistically insignificant as compared to highly significant rise in rate pressure product in the control group.

Changes in serum potassium following succinylcholine in patients with infections

Changes in serum potassium level in 21 control patients and 21 patients with infections of varying severity were measured after administration of succinylcholine. Serum potassium levels increased significantly in patients with infections, but not in the normal control patients. The magnitude of the increase in serum potassium was related to the severity and duration of infection.

Changes in canine bladder perfusion with distension

Using a radioisotope-labeled microsphere technique, canine bladder perfusion was investigated. Blood flow was measured in in flaccid and distended conditions. A slight decrease in total bladder blood flow was recorded. There was a relative decrease in bladder mucosal flow with distension. There was no difference in perfusion of dome versus trigone.

Pre- and postejaculation serum acid phosphatase

A clinical investigation was carried out to analyze the frequency of elevated serum acid phosphatase (SAP) levels after ejaculation and needle biopsy of the prostate gland. Major mechanical manipulative procedures such as needle biopsy caused marked acute elevations in SAP levels but return to normal within twenty-four hours. It is demonstrated that SAP levels remained essentially unchanged after ejaculation. It has been previously shown that procedures such as prostatic massage, catheterization, and endoscopic examination normally do not elicit abnormal SAP levels. Hence any elevation of SAP warrants further evaluation for serious urologic disease.

Intraoperative autologous blood transfusion: report of a technique

Using a simple and relatively inexpensive technique, blood was salvaged during major thoracic and cardiovascular surgery in 34 cases. Detailed haematological, biochemical, and bacteriological studies were carried out, with red cell survival studies. It has been shown that cellular as well as non-cellular elements of the blood were well preserved with little or nor bacterial contamination. It has been suggested that this form of autologous blood is a more suitable form of blood replacement than donor blood.

Successful outcome of complications of excision of aortic coarctation

A case is described of a patient who made a complete recovery following unusually serious complications of excision of aortic coarctation. The thoracic aorta was reconstructed successfully using an aortic graft along a course which appears to be short and direct.

An easily missed foreign body in the respiratory passages

A case is described of a 22-year-old man who had inhaled a piece of shattered windscreen glass following a road traffic accident. The indications for bronchoscopy are discussed and the literature reviewed.