What do we need for airway management of adult casualties on the Primary Casualty Receiving Facility? A review of airway management on Role 3 Afloat

The Primary Casualty Receiving Facility (PCRF) of the Royal Navy (RN) is currently based on Royal Fleet Auxiliary (RFA) ARGUS and provides a functioning hospital with surgical teams and a CT scanner (Role 3) within the maritime environment. The case mix could include complex trauma, critically ill patients returning to theatre several times, as well as non-battle injury procedures. This paper describes how we have used national guidelines, evidence from recent military experience, and the Clinical Guidelines for Operations (CGOs) to review and rationalise the airway equipment that is available and that would be required for the PCRF in its current configuration, whilst maintaining capability in a deployed setting.

A comparison of intercuff and single cuff techniques of intravenous regional anaesthesia using 0.5% prilocaine mixed with technetium 99m-labelled BRIDA

Intravenous regional anaesthesia of the upper limb is a widely used technique first described by Bier in 1908. The exact site of action of injected local anaesthetic has not been determined. We have performed intravenous regional anaesthesia on volunteers using prilocaine mixed with technetium 99m-labelled 2,4,6 trimethyl-3-bromo iminodiacetic acid. Two different techniques of intravenous regional anaesthesia (the 'normal' cuff and the intercuff techniques) were combined with gamma camera tracking of the radiolabel to determine the site of local anaesthetic action. The onset of action was similar for both techniques. The local anaesthetic was mainly retained in the antecubital fossa in both techniques but in the 'normal' technique, the local anaesthetic subsequently showed some retrograde spread. This would suggest that the main site of action of local anaesthetic used for intravenous regional anaesthesia is the larger nerves in the vicinity of the antecubital fossa.

Oxygenation of patients undergoing ophthalmic surgery under local anaesthesia

The oxygenation of 30 patients undergoing elective ophthalmic surgery without sedation whilst breathing air was studied and was compared with two methods of oxygen supplementation. Arterial oxygen saturation, inspired and expired oxygen and carbon dioxide were analysed. The delivery of oxygen at 21.min-1 via nasal cannulae was shown to be superior to a method which directed oxygen from under the surgical drapes.

Lansoprazole in the prophylaxis of acid aspiration during elective surgery

We have assessed the efficacy of a single dose of lansoprazole in increasing the pH and decreasing the volume of gastric residue at induction of anaesthesia in adult patients undergoing elective orthopaedic surgery. We studied 66 ASAI-II patients, allocated to one of three groups to receive either placebo (group 1), lansoprazole 30 mg (group 2) or lansoprazole 60 mg (group 3), 8-12 h before induction of anaesthesia. Volume and pH of gastric contents were measured after induction of anaesthesia by aspiration via a 16-French gauge gastric tube. Patients who received lansoprazole had a significantly higher pH than the placebo group (P < 0.01) but there was no difference between the two lansoprazole groups. The volume of gastric residue was significantly smaller (P < 0.01) in both lansoprazole groups compared with the placebo group: 28% of those in group 3 had a pH of gastric residue < 2.5 and volume > 25 ml compared with 30% in group 2 and 63% in group 1, respectively.

Influence of thyroid autoantibodies on thyroid cellular growth in vitro

Porcine thyroid follicle cells, cultured in suspension, were employed to investigate the effects of immunoglobulin preparations from patients with colloid goitre, Graves' disease or Hashimoto's thyroiditis on thyroid growth in vitro. Epidermal growth factor (EGF, 19 ng/ml) was used as a reference for maximum growth stimulation and produced a 9-fold increase in [3H]thymidine incorporation. Immunoglobulins (1000 micrograms/ml) were found to increase [3H]thymidine incorporation compared to control: from 10 normal individuals 32 +/- 4% (mean +/- SEM, % of EGF response), from 10 patients with colloid goitre 26 +/- 4% (not significantly different from normal), from 10 patients with Graves' disease 19 +/- 3% (P less than 0.05) and from 15 patients with Hashimoto's thyroiditis 11 +/- 2% (P less than 0.001). No patient immunoglobulin preparation showed activity greater than that of normal individuals. The lower growth stimulatory activity in Graves' disease and Hashimoto's thyroiditis remained after heat inactivation of serum and is thought to reflect surface binding of thyroid autoantibodies.