Objectives: The recent introduction of a disposable laryngeal mask airway has provided paramedics with an alternative to endotracheal intubation. Time taken to secure the airway with each device was compared in patients undergoing elective surgery. Methods: Patients undergoing general anaesthesia were studied. Paramedics trained in laryngeal mask use and endotracheal intubation participated in the study. A Portex disposable laryngeal mask was inserted and removed, followed by a Portex endotracheal tube. Time taken from beginning of the procedure to ventilation of the patient was recorded. Results: Laryngeal mask insertion and endotracheal intubation was attempted on 52 patients. Median age was 63.5 years (range 39-83). Laryngeal mask insertion was successful in 88.5% (46 of 52) patients; endotracheal intubation was successful in 71.2% (37 of 52) patients (after no more than two attempts), p = 0.049. Intubation success was related to laryngoscopic view (87.5% grade 1, 56.3% grade 2, 0.0% grade 3. p,0.0001). When laryngeal mask/endotracheal tube insertion were both successful (n = 35 of 52), there was no significant difference in median time to secure the airway (laryngeal mask 47.0 seconds (range 24-126) compared with endotracheal tube 52.0 seconds (range 27-148) p = 0.22). Laryngeal mask insertion was successful in 80.0% (12 of 15) patients in whom endotracheal intubation had failed. Conclusions: Even under optimal conditions, 30% of attempts at intubation by paramedics were unsuccessful. A disposable laryngeal mask has a higher success rate in securing the airway and overall, secures the airway more reliably than endotracheal intubation. P rehospital airway management is one of the most challenging prehospital tasks in the management of patients with major trauma. Paramedics in the UK are taught basic airway management as technicians and progress to learn the skills of endotracheal intubation over an eight week course, entailing the practical intubation of at least 25 patients in a controlled hospital environment. Subsequently, the average paramedic attempts endotracheal intubation on about seven patients per annum, which is relatively few for a technique where skills fade fast. Without the use of sedative and neuromuscular pharmacological agents, endotracheal intubation is only possible on severely obtunded patients. Success rates in these circumstances are variable, but generally poor, with success rates below 75% being regularly reported.

IntroductionCongenital lung malformations are rare lesions that are most commonly diagnosed antenatally. Management of such lesions, particularly those that are asymptomatic, remains controversial. We undertook a survey to ascertain current practice of surgeons in the UK and Ireland.MethodsAll consultant members of the British Association of Paediatric Surgeons were asked to complete a survey on congenital lung malformations with respect to antenatal management, symptomatic and asymptomatic lesions, and operative techniques.ResultsResponses were received from 20 paediatric surgical centres and highlighted the ongoing variability in management of such lesions, particularly those that are asymptomatic. Twenty per cent of surgeons never resect an asymptomatic lesion and twenty-four per cent always do. The remainder intervene selectively, with size being the most commonly stated indication. Most resections are undertaken via thoracotomy although 35% of surgeons use thoracoscopy for some procedures.ConclusionsNational data based on congenital anomaly registers are needed to determine the natural history of these malformations and to guide future management.

Computed tomography with additional selective prone and/or decubitus scanning is highly effective in the diagnosis of mechanical LBO. It is suggested that it replace contrast enema as the initial imaging method.

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The inadvertent formation of a gastrocolic fistula was avoided with the use of laparoscopy to aid PEG insertion.