Acute severe asthma presenting in late pregnancy.

Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.

The post-buckling behaviour of the pressurized abdominal cavity during knees-bent lifts.

When a person bends over to lift an object, the intra-abdominal pressure is insufficient to prevent the abdominal cavity from buckling. This paper is concerned with estimation of the extent of buckling, its effect on the bending moment capability of the abdominal cavity and the stress distributions in the abdominal muscles. Buckling decreases the bending moment capability of the abdominal cavity, increases the stresses in the oblique muscles and transversus, and reduces to zero the stress in the rectus muscles.

Airway adventures in Africa.

Difficult airway management may challenge any anesthesia provider. A clear and protected airway must be maintained even in difficult intubations. In challenging cases, careful preoperative assessment and good communication with colleagues are required.

Estimation of loads and stresses in abdominal muscles during slow lifts.

Calculations are made of abdominal muscle loads and stresses associated with the development of intra-abdominal pressure during slow, symmetrical lifts. The muscles considered are the rectus, transversus and the external and internal obliques. Muscle loads and stresses have been calculated in an abdominal cross-section at about the level of the third lumbar vertebra. For four cases examined, maximum stress levels for men in the 25-35 years age range appear to be 3p-4p for the rectus muscles, 15p-25p for the transversus and 4p-6p for the obliques, where p is the intra-abdominal pressure. Corresponding figures for a man aged 66 years are about 8p, 21p and 8p respectively.

The effect of the laryngeal mask airway on coughing after eye surgery under general anesthesia.

Twenty-nine patients scheduled for elective eye surgery under general anesthesia were randomized into two groups, A and B. After induction of anesthesia, the airway of those in group A was maintained with a conventional tracheal tube; in group B, with a laryngeal mask airway. In the immediate postoperative period, 13 of the 14 patients in group A coughed; none of those in group B did (P < .001).

Management of respiratory complications after maxillofacial surgery on board ship.

An eight year old girl who probably inhaled gastric contents during surgery for cleft palate repair was ventilated for 10 days in the post-operative recovery area on board the Mercy Ship Anastasis with pulse oximetry as the only monitor of oxygenation. She walked off the ship on the seventeenth day.

Use of the Brain laryngeal mask airway in anticipation of difficult tracheal intubation.

Use of the Brain laryngeal mask airway during anaesthesia is described. Its use is shown to have obviated the need for tracheal intubation in the case of a patient whose injuries would have made this technique difficult.