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We have previously reported a standardized stepwise transesophageal echocardiography transverse plane (monoplane) patient examination sequence suitable for intraoperative use. Biplane transesophageal echocardiography furnishes images of the heart and great vessels in both transverse and vertical planes. This report describes a seven-step vertical plane examination, the completion component of a comprehensive intraoperative biplane evaluation. Each step is illustrated by presentation of a two-dimensional echocardiographic image, a matching diagram and a schematic representation of the corresponding axis of interrogation. Examples of clinical presentations complete the report.

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Several brands of laryngoscopes and commonly used blades are evaluated for differences in direct light intensity and area of illumination. The purpose of this study was to determine which laryngoscope/blade combination provided the best lighting conditions for tracheal intubation. The direct light intensity was assessed by directing various laryngoscope/blade combinations towards a multifunction exposure meter (Flash Meter III, Minolta Corp.). Light intensity expressed in Lux was calculated using the formula: lux = 2.5 x 2 exposure index. The area of illumination provided by the laryngoscopes was assessed by taking photographs when the laryngoscope blade tips were touching a wall. The widest diameter of bright illumination in the photograph was measured in centimeters (cm). The direct light intensity ranged from 0.4-5.5 x 10(3)lux. The field of illumination ranged from 3.2 to 8.8 cm. When fitted on regular size handles, blades with incandescent bulbs provided more intense light than blades using fibreoptic light sources (P = 0.0078). For blades using incandescent light, the use of a short handle laryngoscope resulted in a decrease in light intensity (P = 0.0117). The results of this study suggest that blades using incandescent light provide greater light intensity than blades using fibreoptics.

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While stridor is an ominous sign implying severe airway stenosis, not all stridor has an organic aetiology. We present two cases of functional stridor in which the diagnosis was made by the anaesthetist. As experts in the management of difficult airways, anaesthetists should be aware of this clinical entity. Recurrent episodes present as aphonia, dysphonia, dyspnoea, apnoea or unconsciousness. Stridor is usually inspiratory. Flow volume loops show a pattern of variable extrathoracic obstruction with diminished peak inspiratory flow. Awake fibreoptic laryngobronchoscopy reveals normal airway anatomy, intense adduction of false and true vocal cords during inspiration and normal vocal cord motion on expiration. Treatment of functional stridor is supportive. The diagnosis of functional stridor demands exclusion of life-threatening airway stenosis of organic aetiology. A high index of suspicion for this clinical entity will reduce the incidence of unnecessary interventions such as tracheal intubation and tracheostomy.

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Parental presence at induction of anaesthesia is desirable if it makes the child happier and more cooperative. This study evaluated the emotional and behavioural responses of children to being accompanied by a parent at induction of anaesthesia in a paediatric day-care surgical centre. One hundred and thirty-four patients (aged 2-10 yr, ASA physical status I or II) were divided into two groups by day of surgery, to have a parent present at induction of anaesthesia (treatment group), or to be unaccompanied (control group). Before, and at one week after surgery, the child's fears and behaviour were scored by the Hospital Fears Inventory (HFI) and Behavioural Questionnaire (BQ), and parental anxiety by the Parents' Questionnaire (PQ) before and at one week after surgery. The Global Mood Scale (GMS) was used to assess the child's behaviour and the Visual Analogue Scale (VAS) to assess the parent's anxiety on arrival for surgery and at induction of anaesthesia. All patients and parents were disturbed by the experience, but to the same degree in the treatment and control groups. Subgroups of "calm" and "anxious" parents were identified by a median split of their preoperative VAS scores. Children in the "calm-treatment," "calm-control" and "anxious-control" subgroups were similarly upset at induction. Children in the "anxious-treatment" subgroup were the most disturbed at induction, and significantly more than those in the "anxious-control" subgroup. Preoperative parental anxiety levels also correlated with the child's fears and behaviour one week after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

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This study was designed to compare the effect of intraoperative administration of 100% oxygen (F1O2 = 1.0) with 50% O2 (air-O2 mixture, F1O2 = 0.5) on cardiovascular and respiratory parameters in adults undergoing coronary artery surgery. Nineteen patients were assigned to receive either F,O2 = 1.0 (group A) or F1O2 = 0.5 (group B) in a randomized fashion. Anesthesia was induced with fentanyl (15 microg/kg) and diazepam (0.1 to 0.2 mg/kg) and maintained with fentanyl (total dose 50 microg/kg) and isoflurane. A bubble oxygenator (F1O2 = 1.0) was used during cardiopulmonary bypass (CPB) in both groups. Hemodynamic and respiratory profiles were determined at specific intervals prior to incision, following CPB, and postoperatively. Patients ventilated with F1O2 = 0.5 were well oxygenated at measured intraoperative intervals (PaO2 range 90 to 268 mmHg, saturation 95% to 99%), with adequate mixed venous O2 levels (PvO2 range 35 to 65 mmHg, saturation 63% to 89%). Compared with patients receiving F1O2 = 1.0, those receiving F1O2 = 0.5 had significantly greater increases in cardiac index (CI) (mean +/- SEM B: 87% +/- 18% v A: 26% +/- 12%) and stroke index (B: 10% +/- 5% increase vA: 14% +/- 7% decrease), and a larger decrease in peripheral resistance (B: 38% +/- 7% v A: 4% +/- 12%) at postoperative day 1 relative to preincision values (P < 0.05). At postoperative day 1, both groups had an elevated alveolar-to-arterial O2 gradient (A: 55% +/- 19% v B: 48% +/- 17% increase) and shunt fraction (A: 58% +/- 28% v B: 99% +/- 35% increase). Although O2 consumption increased similarly in both groups at postoperative day 1 relative to preincision values (A: 91% +/- 23% v B: 113% +/- 16%), O2 delivery was enhanced more in group B than in group A (67% +/- 17% v 20% +/- 13% increase, respectively, P < 0.05). The data suggest that significant hemodynamic derangements may occur with hyperoxia and that intraoperative administration of 50% O2 may be more appropriate during coronary artery surgery.

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