Latex-free reservoir bags: exchanging one potential hazard for another.

The reservoir bag on the anaesthetic breathing circuit is a safety feature that can protect the patient. It is highly distensible, pressures within the breathing circuit rarely exceeding 3.9 kPa (40 cmH2O) even when the adjustable pressure-limiting valve is inadvertently left closed. In providing a safe latex-free environment in our anaesthetic rooms, the traditional latex rubber reservoir bag is substituted by a latex-free one. To investigate the safety features of several latex-free reservoir bags already in use in our hospital, we assessed the in-circuit pressures obtained at stepped fresh gas flows using a lung simulator. Four out of five of the latex-free bags exceeded pressures of 4.4 kPa (45 cmH2O), raising the possibility that, in trying to avoid an occupational hazard, we might be compromising patient safety. We found that, of the five latex-free systems we tested, only the Intersurgical complete respiratory system provided an adequate safety mechanism for the patient and thus did not potentially compromise patient safety.

Awake craniotomy for removal of intracranial tumor: considerations for early discharge.

UNLABELLED: We retrospectively reviewed the anesthetic management, complications, and discharge time of 241 patients undergoing awake craniotomy for removal of intracranial tumor to determine the feasibility of early discharge. The results were analyzed by using univariate analysis of variance and multiple logistic regression. The median length of stay for inpatients was 4 days. Fifteen patients (6%) were discharged 6 h after surgery and 76 patients (31%) were discharged on the next day. Anesthesia was provided by using local infiltration supplemented with neurolept anesthesia consisting of midazolam, fentanyl, and propofol. There was no significant difference in the total amount of sedation required. Overall, anesthetic complications were minimal. One patient (0.4%) required conversion to general anesthesia and one patient developed a venous air embolus. Fifteen patients (6%) had self-limiting intraoperative seizures that were short-lived. Of the 16 patients scheduled for ambulatory surgery, there was one readmission and one unanticipated admission. It may be feasible to discharge patients on the same or the next day after awake craniotomy for removal of intracranial tumor. However, caution is advised and patient selection must be stringent with regards to the preoperative functional status of the patient, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission. IMPLICATIONS: It may be feasible to perform awake craniotomies for removal of intracranial tumor as an ambulatory procedure; however, caution is advised. Patient selection must be stringent with respect to the patient's preoperative functional status, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission.