SummaryTwenty previously used and supposedly clean, sterilised laryngeal mask airways, five bougies and five Magill forceps from the operating theatre, and 61 laryngoscope blades from different sites within a single hospital were randomly collected and stained with erythrosin B dye, which stains proteins if present on surfaces. All 20 laryngeal mask airways had been used before and were stained: four (20%) showed heavy staining, five (25%) moderate staining and 11 (55%) mild staining. Two unused laryngeal mask airways used as controls were without staining. Thirty-four of 44 (77%) laryngoscope blades taken from the operating theatres, six of seven (86%) from the overnight intensive recovery room and all 10 (100%) from the wards were stained. None of the other items was totally clean. These findings suggest that current cleaning methods do not remove all proteinaceous material.

SummaryTwenty previously used and supposedly clean, sterilised laryngeal mask airways, five bougies and five Magill forceps from the operating theatre, and 61 laryngoscope blades from different sites within a single hospital were randomly collected and stained with erythrosin B dye, which stains proteins if present on surfaces. All 20 laryngeal mask airways had been used before and were stained: four (20%) showed heavy staining, five (25%) moderate staining and 11 (55%) mild staining. Two unused laryngeal mask airways used as controls were without staining. Thirty-four of 44 (77%) laryngoscope blades taken from the operating theatres, six of seven (86%) from the overnight intensive recovery room and all 10 (100%) from the wards were stained. None of the other items was totally clean. These findings suggest that current cleaning methods do not remove all proteinaceous material.

SummaryAcute cardiac herniation after radical pneumonectomy is extremely rare and is associated with an immediate mortality greater than 50%. We report a patient in whom cardiac herniation produced no signs or symptoms. The heart was returned to its correct position and the pericardial defect was repaired.Keywords Complications; acute cardiac herniation. Surgery; thoracic.. ..................................................................................... Correspondence to: Dr R. J. Self Accepted: 26 May 1998 Diffuse malignant mesothelioma of the pleura is associated with exposure to asbestos. It usually presents with increasing dyspnoea and a pleural effusion. The diagnosis is confirmed by the histological examination of either pleural aspirate, or pleural biopsy, or both [1]. The treatment is either by chemotherapy, radiotherapy, surgery or by a combination of all three. Radical surgical treatment involves removal of both layers of the pleura, the lung, part of the pericardium and the diaphragm. We report a patient who had radical surgery and developed a rare complication. Case historyA 36-year-old builder was admitted for a right pleuropneumonectomy for mesothelioma of the right lung [1]. Pre-operatively he was asymptomatic apart from some mild chest pain. He had recently received a general anaesthetic for a thoracoscopy, with no complications. His exercise test, pulmonary function tests and arterial blood gases were within normal limits. A chest X-ray showed some right sided opacities probably due to the pleural thickening.He was premedicated with temazepam 20 mg given orally. Anaesthesia was induced with propofol 200 mg fentanyl 100 mg and vecuronium bromide 10 mg and maintained with isoflurane and nitrous oxide in oxygen. Monitoring included an ECG and direct arterial and central venous pressure measurements.A left-sided double lumen endobronchial tube (DLT) was inserted and its position was checked [2]. A nasogastric tube was passed and again correct placement was confirmed. A thoracic epidural was established at the T 4-5 interspace with the patient in the left lateral position; the lungs were automatically ventilated. The surgical procedure involved removing the right visceral and parietal pleura, the right lung, diaphragm and pericardium. A 10 × 10 cm defect was left in the pericardium on the right side.A single chest drain was attached to an underwater seal and the chest wound closed. At the end of the procedure, the patient remained in the left lateral position during reversal of muscle relaxation, the tracheal tube was removed when he was awake and he was transferred to the recovery area breathing oxygen enriched air. Half an hour after extubation, the patient was obeying commands, was haemodynamically stable and pain free. He was positioned upright in the semi-right lateral position. The routine postoperative chest X-ray ( Fig. 1) showed a significant degree of cardiac herniation with the apex of the heart in the right hemithorax. His blood pressure remained around 110/60 mmHg with a CVP of...

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