The incidence of bacteraemia following laryngeal mask insertion.

The incidence of bacteraemia following insertion of the laryngeal mask airway (LMA) was investigated in one hundred fit patients. Four cultures were positive: three represented contamination with skin flora; the other was a microaerophilic streptococcus grown from an anaerobic culture bottle. Although this organism can be pathogenic, it may also represent contamination. Our findings suggest that significant bacteraemia on insertion of the LMA is uncommon and is probably no more than with oral intubation. Antibiotic prophylaxis is of doubtful benefit in these circumstances.

A potential new technique for awake fibreoptic bronchoscopy--use of the laryngeal mask airway.

OBJECTIVE: To assess the potential use of the laryngeal mask airway (LMA) for awake diagnostic fibreoptic bronchoscopy. DESIGN: A prospective study of 50 patients presenting for awake diagnostic bronchoscopy. All patients were premedicated with pethidine and atropine. The LMA was inserted under topical anaesthesia with sedation and the quality of the subsequent laryngoscopy and bronchoscopy was assessed for both patient and bronchoscopist. SETTING AND PATIENTS: All patients over the age of 18 years who presented to Cairns Base Hospital for diagnostic bronchoscopy were asked to participate in the study. MAIN OUTCOME MEASURES: The main factors determining the suitability of the technique were insertion rate, ease of the laryngoscopy and bronchoscopy, oxygen saturation and patient acceptance. RESULTS: The LMA was inserted successfully in all patients and the bronchoscopy subsequently performed. The first time insertion rate was 72%. The mean oxygen saturation during the procedure was 98% and patients tolerated the technique. CONCLUSIONS: The potential advantages of the LMA are that it is simple to insert, avoids nasal trauma and facilitates direct laryngoscopy. It allows respiration to be monitored and oxygen to be administered. The technique may have a role to play in patients whose respiratory function is in a critical condition, but confirmation of this awaits comparative trials. A period of training is recommended in anaesthetised patients before the LMA is used for awake diagnostic bronchoscopy.

Propranolol overdose--a dramatic response to calcium chloride.

OBJECTIVE: To present a case of severe propranolol overdose which responded dramatically to the administration of calcium chloride. CLINICAL FEATURES: A 22-year-old female Caucasian who was unemployed arrived by ambulance to a hospital emergency department after propranolol overdose. She was convulsing and in electromechanical dissociation. An electrocardiogram showed sinus rhythm with broad QRS complexes. She had no relevant medical history. INTERVENTION: Resuscitation with basic and then advanced life support and administration of oxygen, adrenaline, atropine, fluids and bicarbonate gave no response. Calcium chloride, however, repeatedly produced a dramatic restoration of blood pressure and a narrowing of the QRS complexes. She made a good recovery with no sequelae. CONCLUSION: Calcium chloride may have a role to play in propranolol overdose.