Biomedical subjects
Publications and source records attributed to R M Flowerdew.
This case report describes an inadvertent misconnection of the breathing and scavenging hoses on the anaesthesia machine which resulted in complete expiratory obstruction. The features which facilitate such a misconnection are described and modifications to reduce the likelihood of this event recurring are suggested.
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A case of severe muscular rigidity in a premature male infant born by Caesarean Section under general anaesthesia is described. A probable diagnosis of malignant hyperthermia was supported by the clinical symptoms of muscular rigidity and cyanosis, a creatinine phosphokinase of 24,630 I.U. (Normal 0--100) and a urinary myoglobin of 248 mg/l (normal 6--35). The muscle tone and laboratory values slowly returned to normal over a period of days. Anaesthetic management for a ventriculoperitoneal shunt performed at seven weeks of age included pre and postoperative treatment with dantrolene. No crisis occurred at this time. The parents, who have normal CPK and a negative family history, were advised to treat the child as if he had malignant hyperthermia until such time as a definitive diagnosis can be made.
A new scavenging device suitable for the Jackson-Rees modification to the Ayre's T-piece is described. This device maintains the essential components of the modification while effectively scavenging the circuit.
Ambient nitrous oxide concentrations were recorded in an operating room during delivery of the gas at low and medium flow-rates, with and without the application of simple scavenging devices. Residual background levels of nitrous oxide were still present more than one hour after disconnection of the flowmeters and use of the room. Scavenging reduced concentrations ten-fold. Adjacent corridors and the post-anaesthetic recovery room were contaminated with nitrous oxide from the operating rooms and from patients. A vigorous programme of checking for leaks and repairing and maintaining equipment, coupled with the use of suction scavenging, can reduce atmospheric contamination with nitrous oxide below 30 p.p.m., which is well within the limit suggested by the U.S. National Institute for Occupational Safety and Health.
A new type of lighting device is incorporated into the ether screen cross-bar, enabling better illumination of the patient's face. A 12-V, DC power supply is used. The temperature, with vacuum-assisted cooling, should not cause burns to an unconscious patient. Assessment of patient colour was evaluated and found to be reliable. The lamp must not be used with flammable anaesthetic agents.