Administration of DCLHb allowed a significant number (19%) of cardiac surgery patients to avoid exposure to erythrocytes postoperatively.

Fossil worm tubes of Cretaceous age preserved in the Bayda massive sulfide deposit of the Samail ophiolite, Oman, are apparently the first documented examples of fossils embedded in massive sulfide deposits from the geologic record. The geologic setting of the Bayda deposit and the distinctive mineralogic and textural features of the fossiliferous samples suggest that the Bayda sulfide deposit and fossil fauna are remnants of a Cretaceous sea-floor hydrothermal vent similar to modern hot springs on the East Pacific Rise and the Juan de Fuca Ridge.

SummaryIn 30 ASA 1 and 2 patients undergoing general anaesthesia and neuromuscular paralysis, manual in-line stabilisation of the neck in a neutral position was performed and single-handed cricoid pressure was applied. Vertical displacement was measured from the midpoint of the neck (directly below the cricoid cartilage). Measurements were also made at the tragus of the ear and the shoulder, both of which acted as fixed reference points. Mean neck displacement was 4.6 mm with a range of 0-8 mm. Mean tragus and shoulder displacements were 0.5 mm and 0.9 mm, respectively, with a range of 0-2 mm at each point. Vertical displacement was also measured in 10 patients from a stylet fixed to the posterior aspect of the neck. Mean displacement measured at this point was 5.0 mm with a range of 2-9 mm. Single-handed cricoid pressure caused vertical displacement of the neck of between 4.6 and 5 mm with a range of 0-9 mm. Only some of this movement, i.e. 0.5-0.9 mm (range 0-2 mm) can be accounted for by displacement of the whole patient as determined from measurements at the two fixed reference points. These findings have implications for emergency management of the airway in trauma patients. Anaesthetics, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK Accepted: 9 January 1997 The patient with multiple injuries may require urgent tracheal intubation before it has been possible to exclude significant injury to the cervical spine. Any manipulation or force applied to the potentially damaged neck should be avoided. In order to minimise the risk of cervical damage, intubation is best performed orally, in experienced hands, with the head held firmly in a neutral position after the cervical collar has been removed [1][2][3][4][5]. The majority of trauma victims also present with a full stomach and, thus, in addition to immobilising the cervical spine during intubation, regurgitation of gastric contents and aspiration into the lungs must be avoided. The application of cricoid pressure [6] is the method of choice for preventing aspiration by occlusion of the oesophageal lumen until the airway is secured. The technique can be performed using a single-or double-handed approach, with the second hand supporting the posterior cervical spine. The effect of cricoid pressure on movement of the unsupported cervical spine has not been studied in detail, although a bimanual approach in trauma patients has been recommended in an effort to provide some support and stabilisation to the posterior aspect of the neck [7]. Any unidirectional force applied directly to the cervical vertebrae, i.e. single-handed cricoid pressure, may cause significant neck movement and exacerbate pre-existing spinal cord injury.The aim of this study was to assess and quantify the effect of single-handed cricoid pressure on movement of the neutrally positioned cervical spine in anaesthetised patients. MethodsAfter obtaining local ethics committee approval, 30 ASA 1 and 2 patients, all undergoing elective general anaesthesia 586ᮊ 1997 B...

We carried out a prospective, controlled trial of intra-operative autologous transfusion (IOAT) in cardiac surgery using the Haemonetics Cellsaver 4, to determine the effects on transfusion requirements and early clinical outcome. Intra-operative autologous transfusion in unselected patients resulted in a reduction in the use of red cells in patients undergoing first-time operations (IOAT median 3 units, controls median 4 units, P = 0.0023), with no difference in the use of other blood products. Post-operative haemoglobin was higher in IOAT patients (IOAT 11.6 g/dl +/- 1.1 versus controls 11.2 g/dl +/- 0.98, P < 0.001). There is therefore the potential for a further reduction in homologous blood use in the IOAT group. There was no difference in early clinical outcome in the two groups; in particular the incidence of coagulopathies was not influenced by IOAT. The routine use of IOAT would add substantially to the cost of these operations. The decision to use it must therefore be based on an assessment of the value of the reduction in risk to the patient achieved by a small reduction in homologous donor exposures.

The quantity of blood products used perioperatively during cardiac surgery is known to vary widely between institutions. This study looked at the amount of blood products used perioperatively in 74 consecutive elective cardiac operations in one institution. The results are compared with those from other European centres and a cost analysis carried out. On average 2.33 +/- 0.74 (95% confidence interval 1.93-2.77) units of red cell concentrate were transfused perioperatively per patient. Six (8%) patients received no blood products. In addition a number of preoperative factors were studied in an attempt to identify predictors of transfusion requirements. Age, preoperative haemoglobin, female sex and red cell mass were all found to have some predictive value. In the face of increasing demands on a limited supply of blood products we question the need for cross matching more than four units of red cell concentrate in elective cardiac surgery.