Trends in pathogens colonising the respiratory tract of adult patients with cystic fibrosis, 1985-2005.

INTRODUCTION: The treatment of patients with CF has continued to evolve. We hypothesised that sputum microbiology may have changed as a result of this. METHOD: Retrospective analysis of sputum microbiology from adult CF patients (1985 to 2005) using the Royal Brompton Hospital CF database. RESULTS: Colonisation with Pseudomonas aeruginosa or Staphylococcus aureus between 1985 and 2005 remained stable (77 to 82%, p=0.159; 54 to 47%, p=0.108; respectively). Haemophilus influenzae (48 to 6%; p<0.001), Aspergillus species (18 to 9%; p=0.002) and Burkholderia cepacia complex (9 to 4%; p=0.041) prevalence decreased. Stenotrophomonas maltophilia and MRSA increased (1 to 4%, p=0.02; 1 to 6%, p=0.002, respectively). CONCLUSION: P. aeruginosa colonisation has remained stable; there has been a decline in B. cepacia complex, H. influenzae and Aspergillus sp., and only a small increase in S. maltophilia and MRSA. Intensive antibiotic strategies have been employed, which, so far, have not resulted in clinically significant emergence of new pathogens.

Gum elastic bougie, capnography and apnoeic oxygenation.

BACKGROUND AND AIM: This study assessed the accuracy of using capnography with a modified, hollow gum elastic bougie in predicting tracheal intubation, and its effectiveness as a method of apnoeic oxygenation. METHODS: Patients were randomly allocated to having the gum elastic bougie inserted, under anaesthesia, in the trachea or the oesophagus. End-tidal carbon dioxide measurements were made at 10 and 20 s. The position of the gum elastic bougie was correctly predicted in 89.2% of patients. We tested the apnoeic oxygenation on an anaesthetic simulator model, which is housed in the Scottish Anaesthesia Simulator Centre, Stirling, UK. RESULTS: The time taken for the oxygen saturation to fall to 90% was significantly prolonged when the gum elastic bougie was used for apnoeic oxygenation. CONCLUSION: The modification of the gum elastic bougie allows a more objective assessment of correct placement than the previous tactile method. The current design of bougie is unsuitable but can be modified.

Hemostasis-altering drugs and central neural block. A survey of anesthetic practice in Scotland and the United Kingdom.

BACKGROUND AND OBJECTIVES: There is debate regarding the use of central neural block in the presence of hemostasis-altering drugs. This study aims to examine current practice. METHODS: A survey was made of the members of the Scottish Society of Anaesthetists and the U.K. branch of the European Society of Regional Anaesthesia to determine the pattern of use of central neural block in patients who are receiving drugs known to alter hemostasis. RESULTS: Spinal anesthetics were considered safer than single epidural injections (P < .05) and single epidural injections safer than infusions via epidural catheters (P < .05). CONCLUSIONS: There is general agreement regarding contraindication of central neural block in the presence of full anticoagulation with either heparin or warfarin, but there is less consensus about the use of central neural block in the presence of low-dose subcutaneous heparin. There is some confusion about the role of aspirin and its duration of action.

Anaesthesia for thoracoscopic pleurectomy and ligation of bullae.

A patient is described who, despite severe pre-operative respiratory disability, had her persistent pneumothorax successfully managed by thoracoscopic pleurectomy. The technique causes considerably less pain and interference with respiratory function postoperatively than does conventional thoracotomy. Potential anaesthetic problems arise because of the necessity of insufflating carbon dioxide at pressures of up to 1 kPa to maintain a pneumothorax during surgery.

Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement.

A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200,000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.

Polyphosphoinositide hydrolysis in response to light stimulation of rat and chick retina and retinal rod outer segments.

Phosphoinositides of chick and rat retina were labelled with [3H]inositol. Exposure of retinal preparations to light for 30 s caused loss of labelled phosphatidylinositol 4,5-bisphosphate and to a smaller extent of the other phosphoinositides. Similar light-induced changes were seen when rod outer segment preparations were used and, when these were illuminated in calcium-free media, phosphatidylinositol 4,5-bisphosphate was the only lipid affected. No inositol 1,4,5-trisphosphate was seen after either 30 s or 5 s of illumination of retina or 30 s illumination of rod outer segments. It is concluded that this compound plays no direct part in vertebrate photoreceptor light transduction, though phosphoinositide metabolism might relate to adaptation mechanisms.