Search

Background and objective: The Eschmann multiple-use introducer is widely used in the management of difficult intubations. Transillumination of the neck is less commonly used. We conducted a randomized crossover study comparing the Trachlight® lightwand and Eschmann multiple-use introducer in simulated difficult intubation. Methods: Sixty-four healthy patients were studied using a standard anaesthetic and full muscle relaxation assessed by train of four. A Macintosh laryngoscope was then inserted and then lowered to simulate a Grade 3 view. Tracheal placement was attempted with both Trachlight® lightwand and Eschmann multiple-use introducer in a randomized order. Anaesthetists placing the devices had extensive experience with the Eschmann multiple-use introducer, but only 15 previous uses of the Trachlight®. Success rates and time for tracheal placement were recorded. Results: The Eschmann multiple-use introducer and Trachlight® were successfully placed in 96.8% and 93.7%, respectively (n.s.). Mean (SD) time to intubation for Eschmann multiple-use introducer and Trachlight® were 15(6) and *21(13), respectively (*P < 0.001). Conclusion: The Trachlight® is a potentially useful alternative to the Eschmann multiple-use introducer in difficult intubation. [ABSTRACT FROM AUTHOR]

Pulmonary and renal excretion of isoflurane and its metabolites was studied in nine surgical patients following administration of known quantitities of isoflurane. Uptake and pulmonary washout were predictable by a mathematical model for inert vapors. The agreement between predicted and experimental data supports the view that isoflurane is subject to little or no biotransformation. The average recovery in exhaled air was 95 per cent, SE 7 per cent. The postoperative increase of urinary excretion of fluoride and organic fluorine accounted for less than 0.2 per cent of fluorine administered as isoflurane. This small extent of biotransformation is probably biologically insignificant, but only after extensive clinical experience can the hazard of delayed toxic response be conclusively evaluated.