The ProSeal laryngeal mask in myasthenia gravis.

This case describes the anaesthesia management of a patient with myasthenia gravis who required mastectomy with axillary lymph node clearance. After withholding medical therapy for the myasthenia preoperatively on the day of surgery, anaesthesia was maintained with halothane, nitrous oxide and a remifentanil infusion. Muscle relaxants were avoided, facilitated by the use of a ProSeal (Intravent, Orthofix, Maidenhead, United Kingdom) laryngeal mask airway for positive pressure ventilation. The ProSeal laryngeal mask airway is a new laryngeal mask device with a modified cuff and a drainage tube which has been shown to have advantages over older designs for use during positive pressure ventilation. The rationale for the management of this patient with myasthenia is discussed.

Gender issues among South African anaesthetists.

OBJECTIVE: To study gender issues among South African anaesthetists. SUBJECTS AND DESIGN: A postal survey of all registered anaesthetists in South Africa in December 1999. RESULTS: There were 385 respondents out of a potential 960, giving a response rate of 40%; 77 respondents (20%) were female and 308 (80%) were male. The largest group of males was over 50 years old whereas most females were under 50 years. Most respondents chose anaesthesia because of academic appeal or career opportunities. More females reported experiencing sexual harassment and felt discriminated against in terms of job selection during the training period and with regard to referral practices. Most respondents felt that their colleagues did not treat them differently on account of gender but more females felt that both patients and female nurses treated them less favourably than their male colleagues. More males felt supported in their career by their life partners. More females felt that having children adversely affected academic and promotional aspects of their careers. Despite this, females were more likely to have experienced positive benefits from combining parenting with a career and were also more likely to have worked part time, mainly because of domestic commitments. Most respondents were satisfied with their careers, and would choose both medicine and anaesthesia again. CONCLUSIONS: Our study suggests that female anaesthetists are generally satisfied with their career choice. However, they are exposed to significant gender-related stresses in the workplace, which are exacerbated by time conflicts for those with children. Allowing part-time employment options and creating a less discriminating environment would enable female doctors to achieve their potential.

The proseal laryngeal mask: results of a descriptive trial with experience of 300 cases.

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff and a drainage tube. METHODS: We assessed the PLMA in 300 anaesthetized adults either paralysed or breathing spontaneously. We assessed insertion characteristics, airway seal pressures, haemodynamic response to insertion, ease of gastric tube placement, gastric insufflation, and postoperative sore throat. RESULTS: Insertion was successful in 294 patients (98%) and graded as easy in 274 patients (91%). We found no difference in ease of insertion or success rate with either the introducer or the finger insertion method, or in paralysed or non-paralysed patients. Mean airway seal pressure was 29 cm H2O, and 59 patients (20%) had seal pressures greater than 40 cm H2O. No gastric insufflation was detected. Gastric tube placement was successful in 290 of 294 patients (98.6%). There was no cardiovascular response to insertion, with a small reduction in heart rate 5 min after insertion and significant decreases in mean arterial pressure at 1 and 5 min after insertion. Sore throat was noted in 23% patients after operation and in 16% of patients after 24 h, with 90% of the sore throats described as mild. CONCLUSIONS: The PLMA is a reliable airway management device that can give an effective glottic seal in paralysed and non-paralysed patients. The device allows the easy passage of a gastric tube, causes a minimal haemodynamic response to insertion, and an acceptable incidence of sore throat.

ProSeal laryngeal mask protects against aspiration of fluid in the pharynx.

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new device designed to isolate the airway from the digestive tract. METHODS: We studied the ability of the PLMA to isolate the airway in 103 anaesthetized adults who were breathing spontaneously or given neuromuscular blocking agents, by filling the hypopharynx with methylene blue-dyed saline introduced down the drainage tube once the mask was in place. At the beginning and end of the procedure, a fibre-optic bronchoscope was passed down the airway tube to observe any dyed saline in the bowl of the mask. RESULTS: The PLMA was positioned correctly in all successful attempts (102 out of 103 attempts) and was able to isolate the glottis from fluid in the hypopharynx in all patients initially. Leakage of saline into the bowl of the mask occurred in two patients in whom displacement of the mask was caused by upper airway events during the procedure. In the remaining 100 patients, the glottis was isolated successfully for the duration of the procedure. CONCLUSIONS: The PLMA can be positioned reliably. It can isolate the airway from fluid in the hypopharynx.