British Hyperbaric Association carbon monoxide database, 1993-96.

OBJECTIVES: To study the referral pattern of patients, poisoned with carbon monoxide and subsequently transferred to British hyperbaric oxygen facilities, from April 1993 until March 1996 inclusive. METHODS: A standard dataset was used by hyperbaric facilities within the British Hyperbaric Association. The data on each patient were sent in confidence to the Hyperbaric Unit at Whipps Cross Hospital for analysis. The epidemiology of poisoning and the population studied were analysed. Times of removal from exposure, referral to a hyperbaric facility, arrival at the hyperbaric facility, and start of treatment were recorded. Data on the outcome of the episode were documented in one of the contributing facilities. RESULTS: 575 patients exposed to carbon monoxide were reported as being referred to British hyperbaric facilities in the three years, the busiest facilities being in London and Peterborough. The proportions of accidental and non-accidental exposures were 1:1.05. Of the accidental exposures, central heating faults were responsible in 71.5% of cases (n = 206). Smoke inhalation from fires was responsible for a further 13.5% (n = 39). The mean delay to arrival in a hyperbaric oxygen facility was 9 hours and 15 minutes after removal from exposure. Recovery after treatment was sometimes incomplete. CONCLUSIONS: The reported pattern of referral was regionally weighted towards the south east of England. Smoke inhalation victims were often not referred for hyperbaric oxygen treatment. The delay to treatment was multifactorial; and the mean delay was well in excess of six hours. There is room for improvement in the consistency and speed of referral. Treatment schedules require standardisation. A central advice and referral service would be helpful.

Cardiac dysrhythmias, carbon dioxide tensions and blood halothane concentrations during dental anaesthesia.

Ninety-eight in-patients received halothane anaesthesia for dental surgery following intramuscular premedication with papavaretum and hyoscine. All anaesthetics involved tracheal intubation. Fifty patients breathed spontaneously and 48 were artifically ventilated. The incidence of ectopic dysrhythmias during surgery, both ventricular and supraventricular, was significantly higher in the spontaneously breathing group (34.0%) than in the artificially ventilated group (2.1%). Blood halothane concentrations and end-expiratory carbon dioxide tensions during surgery were both significantly higher in the spontaneously breathing group. However, regression analysis of the data failed to identify either factor as solely responsible for the different incidence of cardiac dysrhythmias. It is likely that at least one further factor is involved.

Penetrating tracheal injury in a child.

A case is reported of a 3.5-year-old child with a stab wound in the neck, that penetrated the trachea. A pneumomediastinum was present. The anaesthetic problems are discussed and the child's management outlined.