Severe acute drug-induced dystonia in the post-operative period requiring tracheal re-intubation.

Ondansetron is a highly selective 5-hydroxytryptamine receptor antagonist and the most commonly used anti-emetic for the prevention of postoperative nausea and vomiting. Ondansetron has a low affinity for dopamine receptors and so extrapyramidal side effects are rare. Here, we present the case of a 14-year-old girl who developed a severe post-operative acute dystonic reaction which included oculogyric crisis. We believe that ondansetron was the most likely cause, although propofol may have been a synergistic or alternative causative agent. The patient had no significant past medical history and had previously undergone two uneventful general anaesthetics which included both ondansetron and propofol. The prolonged duration and severity of the reaction and failure to fully respond to specific treatments resulted in the need for tracheal intubation and transfer to a paediatric intensive care unit. She subsequently recovered uneventfully with no ongoing neurological sequalae. Ondansetron-induced dystonic reactions are rare and unpredictable and can occur in patients who have previously received the drug without complication. They are thought to be caused by an imbalance between inhibitory and excitatory neurotransmitters in the extrapyramidal system. Specific treatments include anticholinergics, antihistamines and benzodiazepines.

Checking the capnograph before anaesthesia: a survey of national practice in the UK.

BACKGROUND AND OBJECTIVE: Recently published guidelines for checking anaesthetic equipment do not contain specific advice on how to check the correct functioning of the capnograph before inducing anaesthesia. METHODS: We undertook a postal survey of UK consultant (physician) anaesthetists to establish what methods for checking the capnograph are currently in use. Two hundred and two questionnaires were sent to consultants in different hospitals and 163 returned, a response rate of 81%. RESULTS: 52.1% consultants of check the capnograph themselves. Of these, 55.3% use their own expired breath to confirm a response to carbon dioxide. Other methods used by consultant anaesthetists to check capnograph function include the machine self-test (16.5%), visual checks of the capnograph and sampling tubing (10.3%), and sampling of patient expired carbon dioxide (7.1%). CONCLUSION: The most common method for testing capnograph function among consultant anaesthetists and their assistants in the UK is the direct measurement of exhaled breath.

100% inspired oxygen from a Hudson mask-a realistic goal?

BACKGROUND: The administration of oxygen at a high-inspired concentration is often required in medicine, particularly in resuscitation of critically ill patients. However, there is a lack of evidence-based guidance on how to achieve this using currently available apparatus. The aim of this study was to assess how maximum inspired oxygen concentrations can be delivered using existing equipment. METHODS: Ten healthy female volunteers breathed oxygen through two types of Hudson non-rebreathing mask with reservoir bag, one with a safety vent in the mask body and the other with a valve replacing this safety vent (3-valve mask). Oxygen flow was adjusted to either 10 or 15 l min(-1) and the masks were fitted to the face either loosely or tightly. The expired oxygen concentration was measured using an oxygen analyzer. FINDINGS: By using the Hudson non-rebreathing mask with three valves, increasing the oxygen flow to 15 l min(-1), and fitting the mask tightly to the face the average expired oxygen fraction could be raised to 0.85. This equates to an average inspired oxygen fraction of 0.97 in these subjects. INTERPRETATION: The three simple measures mentioned above result in a significant improvement in the performance of the Hudson non-rebreathing mask. Together they allow the delivery of an inspired oxygen concentration close to maximum.