722

Correspondence

ment assistants (ODAs). When a bottle was designated ‘empty’, the residual volume was measured using a quill and syringe. These measurements were performed by the two ODAs carrying out this study. Results showed an average residual volume of 3.22 ml per bottle (SD 1.40, range 0.9-6.3 ml, 95% confidence interval 2.93 to 3.51 ml). The residual volume was not significantly affected by the experience of the filler. The wastage of isoflurane in this hospital therefore cost approximately E l 14 per month. Abbott have since informed us that they may shortly supply an alternative filler from Southmedic Inc of Canada. The new filler will they hope negate the ‘nonempty’ empty

bottle problem and will be a longer life product in general use. Department of Anaesthetics, East Surrey Hospital, Redhill, Surrey

P.H. WITTMANN F.W. WITTMANN T. CONNOR J. CONNOR

Reference [I] OHMEDA TEC5 CONTINUOUS FLOWVAPORIZER. Operation and Maintenance Manual. September 1990.

Medical audit-failed intubation in obstetrics

The suggestions made by Dr Lockie and Dr Potter (Anaesthesia, 1992; 47: 273) deserve support; they underline similar points we made recently [1,2]. There is now evidence that the very high failed intubation rates that have been found in obstetrics can be much reduced, but efficient audit is essential to this strategy. May we add another suggestion? We have approached Portex Ltd. about the possibility of their sponsoring an inter-hospitals intubation cup to be awarded each year to the hospital with the smallest number of failed intubations in, say, the last 1000 obstetric general anaesthetics. Friendly rivalry, like that roused by the rugby world cup, is a good way to focus interest. Maternal deaths are very rare, so it is all too easy to forget about them, but arguably they are the most important unsolved problem we have, and

reducing the number of failed intubations would certainly reduce mortality. Portex have kindly said they would think about it; the support of a distinguished international journal, like Anaesthesia, would be valuable. Northwick Hospital and Clinical Research Centre. Harrow. Middlesex HA1 3UJ

R.S. CORMACK F. CARLI

References [I] CORMACK RS, CARLIF, WILLIAMS KN. Unexpected difficult laryngoscopy. Brirish Journal of Anaesthesia I99 1 ; 67: 50 I -2. F. WILLIAMS KN. CORMACK RS. Difficult laryngoscopy. [2] CARLI British Journal of Anaesthesia 1992; 68: I 17-8.

‘Humbug’

Recently a 9 1 -year-old female suffering from paranoid schizophrenia was admitted to this hospital suffering from intermittant attacks of stridor and cyanosis. She was said to have been consuming mint humbugs. She gave no history herself and was uncooperative at examination, but an attack was witnessed by the ENT staff who suspected intermittant obstruction due to a foreign body. The attending ENT surgeon carried out a rigid bronchoscopy, anaesthesia being initially maintained with intravenous propofol, suxamethonium and apnoeic oxygenation. The surgeon had some difficulty passing the bronchoscope but once passed through the larynx no pathology was found and oxygenation was maintained using a standard insufflation technique. The bronchoscope was then

inadvertently withdrawn whilst the patient was still paralysed and the anaesthetist performed a direct laryngoscopy in order to intubate the patient. She was puzzled to find her view of the larynx obscured by a pinkyorange coloured mass. Extraction with Magill’s forceps revealed a complete apricot, some 5 cm in diameter. Subsequent recovery was uneventful. The surgeon suggested that the patient ‘must have coughed it up’ but the anaesthetic observation was that this was ‘humbug’. Royal Devon and E.xeter Hospital, Exeter EX2 5 D W

G.L. MCAULIFFE

Medical audit--failed intubation in obstetrics.

722 Correspondence ment assistants (ODAs). When a bottle was designated ‘empty’, the residual volume was measured using a quill and syringe. These m...
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