No abstract

We have evaluated the reinforced laryngeal mask airway (LMA) for use during dento-alveolar surgery in 100 ASA I and II day-case patients allocated randomly to receive either a nasotracheal tube or reinforced LMA. We recorded ease of airway insertion, airway complications, quality of recovery and replies to a 24-h postoperative questionnaire. In addition, a fibreoptic assessment was made of laryngotracheal soiling, and the effect of head movement and the position of the reinforced LMA. There were no significant differences in difficulty in airway positioning or perioperative oxygen desaturation. Nineteen patients in the nasotracheal tube group had epistaxis (P = 0.001) and laryngotracheal soiling occurred in three of these patients. Two reinforced LMA were dislodged on moving into the operating theatre and in a further five patients in this group there was partial airway obstruction (compared with none in the nasotracheal tube group; P = 0.018) which was caused by downward pressure on the mandible by the surgeon. There were no differences in postoperative complications. No surgeon reported poor access to the operating field. Overall the reinforced LMA provided satisfactory conditions for this surgery but vigilance of the airway was required, especially at the time of extraction.

We studied 40 patients undergoing surgical removal of at least two third molar teeth under general anaesthesia. Patients were allocated randomly to one of two groups: group B (n = 20) received bupivacaine up to 2 mg kg-1, infiltrated around the inferior alveolar nerves bilaterally, and group K (n = 20) received ketorolac 10 mg i.v. at the start of surgery. There were no significant differences between the two groups in postoperative pain scores measured at 1 h using a visual analogue scale. Group K had a significantly lower incidence of side effects related to intraoral anaesthesia. Swallowing, speech and oral continence were significantly better. Group K scored higher for overall patient satisfaction, measured using a visual analogue scale. We failed to demonstrate any difference in early postoperative recovery (coughing, laryngospasm, stridor or arterial oxygen desaturation) between the groups. We conclude that the use of 0.5% bupivacaine infiltration was no more effective than a single 10-mg injection of ketorolac while giving rise to a higher rate of "minor" airway complications and lower patient acceptability.

An 18-year-old man presented to the emergency department following an assault. He complained of left-sided pleuritic chest pain and difficulty breathing. Clinical examination revealed reduced air entry and coarse crepitations at the left lung base. A chest x-ray showed a large opacity at the left lung base that contained multiple cystic areas with air-fluid levels. Due to the history of trauma, a provisional diagnosis of a ruptured hemidiaphragm with small bowel herniation was made. Further imaging, including ultrasound, spiral computed tomography and magnetic resonance angiography, showed an aberrant vessel supplying the opacity and drainage into the pulmonary venous system. A diagnosis of a bronchopulmonary sequestration (intralobar type) was made. The differential diagnosis of the radiographic appearance is also discussed.