Anaesthetic implications of anorexia nervosa.

The provision of anaesthesia for patients suffering from anorexia nervosa or bulimia nervosa is not without its risks. The anaesthetist needs to appreciate that these eating disorders can predispose the patient to significant risk of multi-organ dysfunction related to starvation and purging. Any such organ dysfunction can have serious implications on morbidity and mortality. Therefore, careful peri-operative management is essential to avoid anaesthetic complications. Both disorders are common, with incidences in the general population of up to 30% in girls and young women. A review of the literature on the provision of anaesthesia for anorexic patients was carried out to evaluate the potential impact of these disorders on the patient's physiology and the subsequent implications for anaesthesia.

Percutaneous and surgical tracheostomy.

Percutaneous techniques for elective tracheostomy have provided a quick and relatively simple method that can be performed in the intensive care unit. Evidence-based studies comparing surgical and percutaneous tracheostomies suggest similar complication rates in trained operators of both techniques.

Intravenous magnesium sulphate in the management of refractory bronchospasm in a ventilated asthmatic.

A 25-year-old man with severe asthma was admitted to intensive care for mechanical ventilation. Conventional treatment with beta agonists, theophylline and steroids resulted in little improvement. Magnesium sulphate was used to reduce bronchospasm and airway pressure. This produced considerable clinical improvement, which facilitated weaning from mechanical ventilation.