SummaryA high-quality ultrasound system (Dyasonics Prisma) was used to study the effect of laryngeal mask airway insertion and cuff inflation on the position and relations of the internal jugular vein in eight healthy young patients undergoing elective surgery. On insertion of the laryngeal mask, with the cuff pre-inflated with 10 ml of air, some minor movement was discernible in the larynx. Neither the larynx nor surrounding structures changed significantly in position. However, on full inflation of the laryngeal mask cuff there was a more noticeable movement of the larynx, which visibly distended in an anterior direction. The mean anterior displacement was 0.8 cm (range 0.6-1.1 cm). There was no significant lateral displacement of the carotid artery or internal jugular vein and there was no significant compression of these structures. We conclude that in the presence of a laryngeal mask airway fixed landmarks such as the sternal notch and angle of the jaw should be used to identify the likely position of the internal jugular vein. Difficulty in cannulation may be experienced if the mobile laryngeal structures are used as landmarks. Since the introduction of the laryngeal mask airway (LMA) into wide clinical practice, there has been a great expansion in its clinical applications. In addition to the routine management of the airway of the anaesthetised patient, its use has been suggested in the management of the difficult airway and during cardiopulmonary resuscitation by medical and nonmedical staff [1, 2]. It has also been used during anaesthesia for coronary artery bypass grafting [3]. Anecdotal experience suggests that the insertion of the LMA and inflation of its cuff can subsequently result in difficulty in placement of a cannula into the internal jugular vein.The position of the LMA in relation to the structures of the larynx has been studied radiologically [4]. When the cuff is inflated the thyroid, arytenoid and cricoid cartilages move anteriorly and the tissues overlying the larynx bulge slightly. Cricoid pressure may be impeded by the presence of a laryngeal mask [5] but there is no information on the effect of LMA insertion on the position or patency of either the internal jugular vein or carotid artery. The pressure exerted by the cuff of the LMA can be in the region of 80-110 mmHg [6], which would be sufficient to compress or distort the vein. If this is the case, information about the effect of LMA insertion on the position of the internal jugular vein would be invaluable in cases where its cannulation is contemplated and may reduce the incidence of complications.We therefore decided to study the effect of LMA insertion and cuff inflation on the position of the internal jugular vein using a high-quality ultrasound system (Diasonics Prisma). MethodsHaving obtained written informed consent and local ethics committee approval, we recruited eight patients undergoing elective surgery. These patients were all female, of ASA grade 1 or 2 and aged between 18 and 40 years. All patients had normal anatomy ...

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SUMMARYElbow injuries are commonly seen in accident departments. Patients with possible bony injuries to the elbow were assessed to see if inability to fully extend the elbow was a good indicator of bony injury and hence the need for X-ray.The sensitivity of this test was 90-7% (95% confidence limits 80-7-100-7) and the specificity 69-5% (95% confidence limits 60.3-78.7). Use of this simple test would reduce both radiography costs and unnecessary exposure to radiation.

SummaryMany surgical patients are anxious while waiting to go to the operating theatre in spite of the best preparation with drugs, information and reassurance. It is possible that patients could be more comfortable if allowed a choice of activities before operations. The objective of this study was to find out how pre-operative patients might prefer to occupy their time. We distributed 200 questionnaires to elective surgery patients and 184 (92%) were available for analysis. Of the respondents, 54.1% wanted to be slightly sleepy, 72.0% preferred not to be fast asleep and 57.2% preferred not to be wide awake. Reading (56.8%), listening to music (57.1%) and chatting with other patients (39.9%) were preferred activities. It might be appropriate to ask patients how sedated they would wish to be before their surgery and perhaps have alternatives to sedation available.