To improve drug history taking before anaesthesia, we have previously suggested a checklist with the mnemonic DRUGS (Doctor, Recreational, User, Gynaecological, Sensitivities). We have now tested this mnemonic in 1053 patients admitted for surgery, comparing the results with the information obtained in the original clerking.Use of the mnemonic yielded additional information in 621 patients (59%). Drugs which had gone unrecorded in routine clerking were detected in 24% of patients on medication. Of 199 patients with high alcohol intake, this feature had been recorded in only 38 (19%). Unprescribed medicines, being taken by 158, had been noted in only 31 (20%). Of women taking oral contraceptives or hormone replacement therapy, more than two-thirds had not given this information. Sensitivities had been recorded accurately in 100 patients but the mnemonic yielded relevant information in a further 85.On this evidence, use of the simple DRUGS mnemonic improves drug history taking in anaesthetic practice.

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Intra-abdominal hypertension and abdominal compartment syndrome are increasingly recognised as causes of serious morbidity and mortality in critically injured patients, particularly those with significant burns. Identification of at risk patients, routine monitoring of intra-abdominal pressures and appropriate, early treatment may reduce the incidence and complication rate of abdominal compartment syndrome and so improve outcomes in critically injured personnel. We present the case of an American Marine injured in an explosion while on patrol in Afghanistan, who despite the absence of significant intraabdominal injury, went on to develop abdominal compartment syndrome and required decompressive laparotomy.

SummaryFifty female patients were studied to compare the view of the larynx at direct laryngoscopy under general anaesthesia with and without cricoid pressure applied. We also compared the view using the standard technique of cricoid pressure with that using cricoid pressure in an upward and backward direction and further investigated whether these views were improved with a firm foam rubber neck support. The order in which the types of cricoid pressure were applied was randomised and also blinded with a drape over the neck. Cricoid pressure was simulated on weighing scales after each case and a mean force of 3.2 kg was applied. The majority of views at laryngoscopy (95%) were grade 1, with too few grade 2 and 3 views for statistical comparison. Both types of cricoid pressure applied without neck support were more likely to give a better view than no cricoid pressure (p < 0.01) and cricoid pressure in an upward and backward direction was more likely to give a better view at laryngoscopy than the standard technique (p < 0.01). Neck support during the standard technique of cricoid pressure did not improve the view of the larynx at laryngoscopy. Cricoid pressure is likely to improve the view at laryngoscopy which may be further improved by applying it in an upward and backward direction.Keywords Larynx; cricoid pressure. Intubation; tracheal. ...................................................................................... Correspondence to: R. G. Vanner Accepted: 17 February 1997 Cricoid pressure is routinely used to prevent regurgitation of gastric contents into the pharynx during the induction of general anaesthesia in all the Maternity Units recently surveyed in the UK [1]. However, it has been suggested that the use of cricoid pressure may make tracheal intubation more difficult [2, 3]. It is not clear whether poor technique alone is responsible or whether correctly applied cricoid pressure may also cause difficulty with intubation. Although it is well known that a degree of pressure on the front of the larynx can improve the view at laryngoscopy [4] it is not known whether correctly applied cricoid pressure, at a force that would prevent regurgitation, alters the view at laryngoscopy.Neck support has been recommended to improve the view at laryngoscopy during the application of cricoid pressure by preventing the head flexing on the neck, either with a bimanual technique [5] or with a cuboid of foam rubber [6]. Bimanual cricoid pressure has been adopted widely [1, 7] despite the lack of evidence supporting this hypothesis; indeed one recent study showed no improvement in the view at laryngoscopy when comparing bimanual with single handed cricoid pressure [8].If the arch of the cricoid cartilage is pushed in an upward (cephalad) direction [9], or the whole larynx is moved in an upward direction [10, 11], the view at laryngoscopy is improved compared with the view with no external manipulation. Therefore, cricoid pressure applied in an upward and backward direction with enough force to prevent reg...