The immediate treatment of frostbite in the American and German armies in Europe during World War 2: an historical perspective.

This historical account, based on a survey of 250 medical articles written during and immediately after World War II, reviews the immediate treatment of frostbite in the American and German ground troops in Europe from 1941 to 1945. The American management was simpler and more conservative than the elaborate treatments reported in the German publications. Because the German patients' injuries were more severe than those of the American soldiers and because neither Army carried out strict clinical trials nor prolonged follow-ups, it is impossible to judge what treatment was superior.

The short, tragic life of Robert M. Glover.

Robert Mortimer Glover (1815-1859) was a contemporary of John Snow and James Young Simpson. Although he did not reach the standing of those two giants, his researches, writings and lectures were important contributions to the early development of British anaesthesia. Glover was the first to explore the physiological action of chloroform in the laboratory and to discover its anaesthetic effect in 1842. He helped Sir John Fife in Hannah Greener's autopsy in January 1848 and influenced Fife's conclusions on the cause of the young girl's death. His numerous and extensive articles reviewing the history, chemistry, pharmacology and clinical applications of various anaesthetics were widely read and quoted by his colleagues, including John Snow. While in Edinburgh and Newcastle, Glover was recognised as a remarkably astute physician, original researcher, prolific writer and enthusiastic lecturer with an enormous knowledge of medicine, the physical sciences, mathematics and philosophy. His brilliant career deteriorated after his arrival in London and, especially, after his return from the Crimea, although he continued to publish until the week before his death. The causes of his decline remain obscure. The last year of his life was ruined by his addiction to chloroform, to whose development he had contributed so much, and which killed him at the early age of 43.

Laryngeal mask airway in severe cervical ankylosis.

PURPOSE: We present a case of the successful use of a laryngeal airway (LMA) to ventilate the lungs of a patient with severe ankylosing spondylitis for surgery requiring intense muscular relaxation. The use of an LMA in such circumstances is controversial. CLINICAL FEATURES: The patient was a 61-yr-old man with severe emphysema, a cervical spine fixed in marked anterior flexion, and reduced mouth opening (35 mm). The patient refused an awake tracheal intubation because of a previous distressing experience with a fibreoptic awake nasal intubation and an 11 day SICU stay with controlled ventilation via an endotracheal tube. Attempts at spinal blocks had failed in the past. After administration of thiopentone and succinylcholine a #4 LMA was inserted and the lungs were safely ventilated for a 10 min reduction of a dislocated femoral head. CONCLUSION: The present view that severe ankylosing spondylitis is a contraindication to the use of an LMA may need revision in view of this and other reports of successful airway management in patients with that disease.

Subarachnoid injection during retrobulbar block: a case report.

Subarachnoid injection during a retrobulbar block is a rare complication, requiring prompt recognition and management of life-threatening respiratory and cardiac depression. This case report describes a patient who began to decompensate 2 minutes after receiving a retrobulbar block. Central nervous system symptoms progressed from restlessness and confusion to respiratory arrest and cardiac depression. Intubation, ventilatory support, and treatment of mild bradycardia and hypotension were provided. One hour after the incident, the patient was fully awake and was extubated. Brain stem anesthesia was suspected. Causes of respiratory arrest and unconsciousness after retrobulbar block include severe anaphylactic reaction, intravascular absorption, a major cardiovascular event, and subarachnoid injection of local anesthetic. The patient's symptoms in the case presented here suggested that the local anesthetic gained access to the cerebrospinal fluid. Anesthetists should be cognizant of the need to monitor and treat serious complications whenever a retrobulbar block is utilized.

Poststernotomy neuralgia: a new pain syndrome.

Fifty-four patients developed severe intercostal neuralgia a few weeks after sternotomy. Immediate relief afforded by parasternal nerve blocks confirmed that the pain derived from scar-entrapped neuromas of the anterior rami of the first 4-6 intercostal nerves in the upper (and mainly left) interchondral spaces after insertion of the sternal wires. Permanent relief (i.e., over 6 months) followed repeated bupivacaine blocks in 57.4% of the patients, phenol blocks in another 22.2%, and alcohol blocks in a remaining 9%. Treatment was successful in 87% of the patients.