Arterial blood gases from central venous lines: a sign for malformation.

Single-operator real-time ultrasound-guidance to aim and insert a lumbar epidural needle. curved needle set refines ultrasound guided ganglion impar neuro-lysis. Needle echogenicity in sono-graphically guided regional anesthesia: blinded comparison of 4 enhanced needles and validation of visual criteria for evaluation. 'Do as you would be done by': the ethics of using outdated equipment in medical charity Editor—Charity in medicine offers treatment to sick people that would not normally be within their reach. Medical charities provide expertise and equipment to recipients in the developing world; however, the safety standards of the donor agency are often very different from those in the recipient country. We present an incident of an endotracheal tube (ET tube) patency failure that might have turned fatal had one not been vigilant, and this incident occurred during major cardiac surgery in the developing world as part of a charity programme in a teaching hospital. A 63-yr-old male was accepted for aortic valve replacement and on the day of surgery, the patient was anaesthetized and intubated with an 8.5 mm ET tube. Mechanical ventilation was commenced with satisfactory E ′ CO 2 , oxygenation, and airway pressures. A transoesophageal echocardiography (TOE) probe was inserted into his oesophagus to assess the aortic valve replacement perioperatively. Soon after the TOE probe insertion, the anaesthetic machine recorded raised airway pressures that increased to 58 cm H 2 O. The tidal volume started decreasing and soon apnoea was recorded with no trace of E ′ CO 2. All measures were taken to recheck the anaesthesia circuit for any obstructions or leaks from the patient end to the machine. The presence of the TOE was felt a hindrance to patient safety and removed without dislodging the ET tube. Instantly, there was sign of relief among the anaesthetists asthere was air transfer and reappearance of E ′ CO 2. Soon the ventilation returned to safety limits, the surgery was finished uneventful and the patient made a smooth recovery. In our case, being a charity mission, post-expiry-dated instruments were used, provided there was no danger to the patient. The portex ET tube used in our patient was manufactured in 1985. Older ET tubes may wane in their texture over a period of time becoming soft, but there is no way to discern this from simply inspecting the ET tube or the pack. In addition, this process may be accelerated in temperate countries where ambient temperatures can …