This audit aimed to assess the identification and treatment of coronary risk factors, lifestyle advice given and use of drug therapy, among patients with angina in Sandwell. It was designed to help general practices evaluate their angina management, and highlight areas where practice could be improved. Criteria were based on Sandwell's published angina audit and local clinical guidelines. Each participating practice was asked to identify all patients with angina, from which a 10% sample was randomly selected. The notes of each selected patient were examined for evidence showing whether agreed standards of care had been achieved. Fifteen practices took part, and contributed data on a total of 358 patients. Of patients without contraindications, 66.5% were taking aspirin, 62.1% were prescribed short-acting nitrates and 58.4% were prescribed beta-blockers. Non-white patients were significantly less likely to receive short-acting nitrates (p < 0.001) and women were significantly less likely to receive beta-blockers (p < 0.01). A total of 83.5% of patients had received smoking cessation advice, 75.1% had weight advice, 75.1% were advised about alcohol use and 64.5% about exercise. Overall, 77.4% had a blood pressure check within the previous twelve months, 40.5% had their cholesterol measured and 33.5% had their blood glucose measured. Non-white patients were significantly less likely to receive smoking cessation, weight, exercise and alcohol advice and were less likely to have their blood pressure checked (all p < 0.0001). Patients aged 65 and over were significantly less likely to receive a cholesterol check (p < 0.0001). None of the auditable standards were actually met. This study shows that there is considerable scope to improve the management of angina patients, with particular regard to aspirin. We recommend that practices develop systems to ensure that the appropriate treatment, advice and checks are given to all patients with angina, paying particular attention to those from ethnic minority backgrounds.

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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