Robert D. Warters

Desmopressin before liver transplantation.

ante-room or inside patient’s room. The PAPR system consists of a belt-mounted powered air purifier (Figure, left) with a HEPA filter, connected via a tube to a light-weight head-piece (Figure, right). The HEPA filter removes particles of 0.3–15 mm with an efficiency of 98–100%.4 We have several years experience in using the PAPR system in the bronchoscopy suite and there are no documentation of disease transmission to health-care workers. The PAPR system has been suggested by the World Health Organization and the Center for Disease Control for SARS protection. It takes time to setup properly (steps 1–7). Therefore, it is crucial to have advance warning of patients requiring intubation. Furthermore, staff involved in intubation must be trained and familiar with the personal protection equipment so that it can be applied properly and expediently (steps 5–7); and removed properly to avoid contamination. As traditional respiratory and contact precautions have been shown to provide inadequate protection against SARS, we have developed this protocol which offers improved protection. The intubation protection protocol should be utilized whenever suspected SARS or infectious patients are encountered.

Loss of resistance technique for locating the epidural space: evaluation of glass and plastic syringes

Location of the epidural space in epidural anaesthesia usually involves the measurement of loss of resistance using glass or plastic syringes. In the present study two varieties of glass syringe and one plastic type were evaluated to determine the resistive forces associated with plunger movement. The mean static (fs) and dynamic (fd) forces for polished glass syringes having a ground plunger only were fs = 0.47 × 10−3 ± 0.22 × 10−3 N and fd=0.37 × 10−3 ± 0.19 × 10−3 N and for polished glass syringes having a ground barrel and plunger were fs = 0.43 × 10−3 ± 0.16 × 10−3 N and fd = 0.38 × 10−3 ± 0.I5 × 10−3 N. Each of these values was significantly lower (P < 0.5) than those for plastic syringes fs = 2.22 × 10−3 ± 0.48 × 10−3 N and fd = 1.46 × 10−3 ± 0.37 × 10−3 N. It is concluded that glass syringes are favoured over plastic for locating the epidural space because frictional forces developed with glass syringes were significantly lower than with plastic.RésuméAfin de trouver l’espace épidural on a recours habituellement à la perte de résistance dans les seringues de verre ou de plastique. Dans cette étude, on a évalué deux variétés de seringues de verre et un type de seringue en plastique, afin de déterminer les forces de résistance associées au mouvement du piston. Les forces moyennes statiques (fs) et dynamiques (fd) pour les seringues de verre poli ayant un plongeur dépoli était de fs = 0,47 × 10−3 ± 0,22 × 10−3 N etfd = 0,37 × 10−3 ± 0,19 × 10−3 N alors que pour les seringues de verre poli ayant un barillet et un piston dépoli était de fs = 0,43 × 10−3 ± 0.16 ± 10−3 N et fd = 0,38 × 10−3 ± 0,15 × 10−3 N. Chacune de ces valeurs étaient significativement plus basses (P < 0.05) de celles des seringues en plastiques fs = 2,22 × 10−3 ± 0,48 × 10−3 N et fd = 1,46 × 10−3 ± 0,37 × 10−3 N. On conclut que les seringues de verre sont meilleures que celles en plastique pour localiser l’espace épidural.

A comparison of different methods of lubrication of glass syringes used to identify the epidural space

Measurement of loss of resistance in glass syringes is a method widely used to locate the epidural space in epidural anaesthesia. Static and dynamic forces were measured under four experimental conditions in new glass syringes: unpolished, dry; polished, dry; unpolished, saline lubricated; and polished, saline lubricated. The unpolished saline lubricated syringes had a mean (SD) static force of 53.18 (15.0) g and dynamic force of 40.88 (15.2) g. These values were significantly greater than for polished dry syringes where the values were 5.27 (2.1) g and 4.38 (0.94) g, respectively. The results show that the least amount of resistance to plunger movement is obtained by dry polishing glass syringes.

Loss of Resistance Technique for Locating the Epidural Space: Evaluation of Glass and Plastic Syringes

Location of the epidural space in epidural anaesthesia usually involves the measurement of loss of resistance using glass or plastic syringes. In the present study two varieties of glass syringe and one plastic type were evaluated to determine the resistive forces associated with plunger movement. The mean static (fs) and dynamic (fd) forces for polished glass syringes having a ground plunger only were fs = 0.47 X 10(-3) +/- 0.22 X 10(-3) N and fd = 0.37 X 10(-3) +/- 0.19 X 10(-3) N and for polished glass syringes having a ground barrel and plunger were fs = 0.43 X 10(-3) +/- 0.16 X 10(-3) N and fd = 0.38 X 10(-3) +/- 0.15 X 10(-3) N. Each of these values was significantly lower (P less than 0.5) than those for plastic syringes fs = 2.22 X 10(-3) +/- 0.48 X 10(-3) N and fd = 1.46 X 10(-3) +/- 0.37 X 10(-3) N. It is concluded that glass syringes are favoured over plastic for locating the epidural space because frictional forces developed with glass syringes were significantly lower than with plastic.