Dental anaesthesia for a child with complete amelia.

A four year-old boy born without limbs (amelia) presented for dental restorations under general anaesthesia as an outpatient. Following intramuscular atropine administration anaesthesia was induced using halothane, oxygen and nitrous oxide inhaled by mask. Next, intravenous access was secured by external jugular vein catheterization. Because of his small mouth, hypognathic mandible, arched palate and anterior-superiorly located larynx, oral intubation under deep anaesthesia during spontaneous ventilation was difficult. The epiglottis was noted to be inverted on subsequent laryngoscopic inspection after intubation but was reduced mechanically to anatomic position. Despite being unable to accurately monitor the blood pressure the intraoperative period was uneventful. Postoperatively the patient was extubated and was able to return home the same day.

Needle tracheostomy: a laboratory study.

Percutaneous needle tracheostomy and transtracheal ventilation continues to be advocated for the management of upper airway obstruction. Recent studies recommend the use of artificial ventilation. However, as apparatus for this is not always available and because there remains some doubt regarding conditions for successful use of needle tracheostomy during spontaneous respiration, we undertook such a study in dogs. Pressure-flow characteristics of short hollow needles 18-10 SWG were first determined. The smallest of these (14 SWG Bardic Intracath) that would deliver flow sufficient (by calculation) to meet the respiratory requirement of 10-13 kg laboratory dogs was selected for further study. Respiration was possible by spontaneous or artificial methods in the presence of complete tracheal occlusion. Little or no deterioration was noted in an hour of such breathing. Artificial ventilation by machine and by hand could considerably lower PaCO2. We conclude that the technique is possible provided appropriate needles are selected and care is given to their method of use.

The importance of monitoring during operations on conjoined twins.

Besides complete and careful preoperative investigation of thoracopagus conjoined twins, monitoring of the various parameters, such as arterial blood pressure, central venous pressure, blood pH, and temperature, are most essential for accurate blood replacement, maintenance of normal body chemistry and thermoregulation. Equally important is continued monitoring in the postoperative period when assisted ventilation may be required as well.Twin "A" returned from the operating room in excellent condition, breathing spontaneously through an endotracheal tube. Twin "B" returned on positive-pressure-assisted ventilation; this was to prove a poor prognostic sign as this twin died eight hours postoperatively.