Evaluation of two warming systems after cardiopulmonary bypass.

We have compared the Thermomat electric undermattress (JMW Systems, Edinburgh, UK) and the Bair Hugger (Augustine Medical, Courtelary, Switzerland) forced-air warming blanket in 30 adult patients after cardiac surgery. All patients were warmed to an oesophageal temperature of 38 degrees C before termination of cardiopulmonary bypass (CPB); those with oesophageal temperatures < 35.5 degrees C at skin closure were allocated randomly to be rewarmed in the intensive care unit either on the Thermomat (n = 15) or under the Bair Hugger blanket (n = 15), at their highest settings. Oesophageal and lateral thigh skin temperatures were recorded every 15 min for 4 h. There was a significantly faster increase in core temperature (0.5 vs 0.75 degrees C h-1; P < 0.0002) and skin temperature (0.86 vs 1.3 degrees C h-1; P < 0.001) in the Bair Hugger group. However, there was no difference in the number of patients who reached a core temperature of 36 degrees C (15 Bair Hugger, 14 Thermomat) or 37 degrees C (11 Bair Hugger, seven Thermomat), or in the number of patients who reached a skin temperature of 37 degrees C in 4 h (four Bair Hugger, one Thermomat). Twelve patients in the Bair Hugger group reached a skin temperature of 36 degrees C compared with two in the Thermomat group (P < 0.001). The Bair Hugger warmed faster than the Thermomat both centrally and peripherally, and warmed more patients to a core temperature of 37 degrees C in 4 h, but did not reduce the time to tracheal extubation or alter important clinical aspects of postoperative course.

Anaesthetic management of the Kenny-Caffey syndrome using the laryngeal mask.

We report the anaesthetic management of a nine-year-old, 6.8 kg, 75 cm tall female with the Kenny-Caffey syndrome presenting for strabismus surgery. Dysmorphic features in our patient included a hypoplastic mandible. A neonatal (size 1) laryngeal mask was successfully used for management of the airway whilst providing surgical access. The general features of this rare syndrome are presented and the literature reviewed.

Hyperventilation-induced unconsciousness during labour.

We report the development of unconsciousness caused by hyperventilation in an otherwise healthy woman in labour. Extradural analgesia resulted in restoration of full consciousness and normal respiratory state. The pathophysiology of hyperventilation and aspects of respiratory physiology in pregnancy are discussed.