High-frequency jet ventilation (HFJV) is a safe, effective anaesthetic technique with a low risk of aspiration which has not yet gained wide acceptance in laryngology. Following anaesthesia and muscular relaxation the patient is intubated with a size 7FG infant feeding catheter and ventilation is achieved by delivering small bursts of anaesthetic gas at high frequency. The mechanisms of gas exchange are thought to be little different from those of conventional ventilation. We have found HFJV to be of value in laryngoscopy, laryngo-tracheal reconstruction, tracheoplasty, bronchoscopy and tonsillectomy.The advantages include:(a) ease of intubation, especially in the presence of a supraglottic mass;(b) improved surgical access compared with a conventional endotracheal tube; and(c) protection of the airway by the inherent ‘auto-PEEP’ effect. Care must be taken to ensure that conditions allow adequate exhaust of expired gas. Humidification of inspired gas is essential during prolonged procedures.

SummaryA survey by questionnare was carried out to look into the provision of facilities for the secondary transfer of head injuredpatients, as well as d@culties encountered. An 84.6% response rate was achieved from 110 hospitals in six regions in the south of England. The results showed that 21 % of hospitals had been unable to make a transfer in the previous year, and delays were commonly experienced by 23.7% of hospitals. The nursing attendance during transfer was satisfactory, but the quality of medical escort was poor, and the standard of monitoring equipment available was unacceptable. Methods of improving the situation include implementation of the recommendations of the Royal College of Surgeons, as well as the Association of Anaesthetists' recommendations for standards of monitoring and provision of intensive care.

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An audit of 151 central venous catheters (CVCs) in 118 children with malignant disease was carried out over 20 months. The types included 31 valved silastic (Groshong), 58 non-valved silastic (Hickman), and 62 non-valved polyurethane (Cuff Cath) CVCs. There was no difference between the three groups with regard to the clinical diagnosis. The mean patient age at catheter insertion was 5.5 years and the mean weight 21.6 kg. None of the catheter types were associated with an increased risk of problems at insertion, migration, mechanical damage, blockage, sampling, or catheter infection. The incidence of catheter infection was 1.4/1,000 catheter days. Exit-site infection was less frequent with Groshong CVCs (P <0.05), which were in situ for the shortest period. The risk of problems with blood sampling was significantly increased in those catheters whose tip was sited outside the right atrium (P <0.005). For the 60 CVCs removed electively, the mean duration in situ was similar for all catheter types; 43 were removed following a problem. Of these, Groshong catheters were in situ for the shortest period (P = 0.05), probably as a result of delayed anchoring of the cuff. The tip position was the single most important determinant in the correct functioning of CVCs, irrespective of the type of catheter. Intraoperative screening of the tip position at catheter insertion is therefore mandatory for optimal catheter functioning.

The effectiveness of administration of glycopyrrolate 5 and 10 micrograms kg-1 and atropine 10 and 20 micrograms kg-1 i.v. immediately before the induction of anaesthesia, to prevent arrhythmia and bradycardia following repeated doses of suxamethonium in children, was studied. A control group was included for comparison with the lower dose range of glycopyrrolate and atropine. A frequency of bradycardia of 50% was noted in the control group, but this was not significantly different from the frequency with the active drugs. Bradycardia (defined as a decrease in heart rate to less than 50 beat min-1) was prevented when the larger dose of either active drug was used. It is recommended that either glycopyrrolate 10 micrograms kg-1 or atropine 20 micrograms kg-1 i.v. should immediately precede induction of anaesthesia, in children, if the repeated administration of suxamethonium is anticipated.