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S.I. UNITS
Br.J. Anaesth. (1977), 49, 951
CORRESPONDENCE TRACHEAL CYLINDROMA: ANAESTHETIC MANAGEMENT
Sir,—Operations for the excision of tracheal lesions present an interesting challenge to the Thoracic Anaesthetist. Drs Lippmann and Mok (1977) are to be congratulated on having managed successfully the anaesthetic problems which occurred during a lengthy and difficult operation for the resection of an extensive tracheal cylindroma in a middleaged man. However, their having commented on the impracticability of using "double lumen tracheo-bronchial dividers" and, in fact, having used a fairly conventional method of intubation for this type of operation, it is difficult to understand the relevance of figure 2. This illustrates an array of "tracheobronchial dividers", some of which, not being described in the text, will be unfamiliar to your readers. Figure 4 shows the sterile circuit which was used to connect the left endobronchial tube to the anaesthetic equipment. This circuit appears to consist of the usual 1-m lengths of corrugated tubing attached to a Y-piece. At the Wessex Regional Thoracic Unit, Southampton, we have found that a sterile, lightweight coaxial circuit, of either the Bain or Penlon type (Henville and Adams, 1976), has simplified the anaesthetic management in three patients who have had successful operations for the excision of tracheal strictures followed by a Grills-type repair. The extra length of the coaxial circuit looped on the patient's chest has allowed freedom for the surgeon to move the tubing as required in order to obtain the best access and view for performing the tracheal anastomosis. It has also allowed the anaesthetist freedom to position his anaesthetic equipment comfortably away from the operating team clustered around the head of the operating table. The coaxial circuit was ventilated with either a modified Cape-Waine Mark 3 Ventilator or a Pneupac Ventilator (Adams and Henville, 1977) according to the principles described by Adams (1977).
J. SELWYN CRAWFORD
Birmingham REFERENCES
Gilston, A. (1977). S.I. Units. Br.J. Anaesth., 49, 394.
Sir,—In bemoaning the increasing use of S.I. units Dr Gilston (1977) may take comfort from the fact that he is not E. S. MACHELL alone. In the April edition of Construction News Magazine Southampton appears an article entitled "S.I.: it has to be" (Feilden, 1977). The first paragraph reads "Over the last year there REFERENCES have been a number of articles in technical magazines Adams, A. P. (1977). The Bain circuit. Anaesthesia, 32, 46. indicating a desperate rearguard action to counter the Henville, J. D. (1977). A new generation of anaesthetic inevitable spread and application of the International ventilators. The Pneupac and Penlon A-P. Anaesthesia, System of Units or S.I. for short." 32,34. A two-page article "The great measurement muddle" appeared elsewhere in the same Journal (Meadows, 1977). Henville, J. D., and Adams, A. P. (1976). A coaxial breathing circuit and scavenging valve. Anaesthesia, 31,257. The confusion resulting from the use of different systems of units in different parts of the World is as great in the Lippmann, M., and Mok, M. S. (1977). Tracheal cylindroma: anaesthetic management. Br.J. Anaesth., 49, 383. construction industry as it is in our own profession. A. G. HAMILTON
Reading
Sir,—We would like to answer Dr Machell's letter as follows. REFERENCES Figure 2 represents an array of endotracheal tubes, Feilden, G. B. R. (1977). S.I.: it has to be. Construction including a Carlen's double-lumen tube, which we designed specially for this patient in anticipation of complications News Magazine, 3,5. that might have taken place either on initial intubation or Gilston, A. (1977). S.I. units. Br.J. Anaesth., 49,394. Meadows, E. (1977). The great measurement muddle. during the operation itself. It was initially thought that a Carlen's tube might work, but after viewing the lesion via Construction News Magazine, 3,46.
Downloaded from http://bja.oxfordjournals.org/ at University of Ulster on June 28, 2015
S.I. UNITS
Sir,—I write to express wholehearted support for Dr Alan Gilston's plea (Gilston, 1977), and am not impressed by your own prevarication in the matter. As far as I can gather, apart from ourselves the only countries which have been subjected to authoritative implementation of the innovation are Australia and Denmark. Even in France, where the whole business was started, presumably, the Systeme has not been put to practical use. If an engineer and a biologist wish to communicate on a matter of common scientific interest, doubtless each would have sufficient intelligence to be able to appreciate the terminology used by the other, without recourse to an artificially standardized common nomenclature. Language poses what is probably the greatest barrier to the dissemination of information, and although many journals, including your own, have adopted the admirable system of presenting a summary of each original paper published in a selection of languages I have yet to learn of a move to legislate that all contributions to scientific journals be written in Esperanto. If we pursue this folly we shall place upon our current trainees and their successors the burden of furnishing themselves with a conversion table to be consulted each time they read a journal or a textbook published in North America or elsewhere. Do, please, have the courage of the convictions implicit in your reply to Dr Gilston, and by example lead an Editorial rejection of this most unpopular monstrosity.
CORRESPONDENCE TRACHEAL CYLINDROMA: ANAESTHETIC MANAGEMENT
Sir,—Operations for the excision of tracheal lesions present an interesting challenge to the Thoracic Anaesthetist. Drs Lippmann and Mok (1977) are to be congratulated on having managed successfully the anaesthetic problems which occurred during a lengthy and difficult operation for the resection of an extensive tracheal cylindroma in a middleaged man. However, their having commented on the impracticability of using "double lumen tracheo-bronchial dividers" and, in fact, having used a fairly conventional method of intubation for this type of operation, it is difficult to understand the relevance of figure 2. This illustrates an array of "tracheobronchial dividers", some of which, not being described in the text, will be unfamiliar to your readers. Figure 4 shows the sterile circuit which was used to connect the left endobronchial tube to the anaesthetic equipment. This circuit appears to consist of the usual 1-m lengths of corrugated tubing attached to a Y-piece. At the Wessex Regional Thoracic Unit, Southampton, we have found that a sterile, lightweight coaxial circuit, of either the Bain or Penlon type (Henville and Adams, 1976), has simplified the anaesthetic management in three patients who have had successful operations for the excision of tracheal strictures followed by a Grills-type repair. The extra length of the coaxial circuit looped on the patient's chest has allowed freedom for the surgeon to move the tubing as required in order to obtain the best access and view for performing the tracheal anastomosis. It has also allowed the anaesthetist freedom to position his anaesthetic equipment comfortably away from the operating team clustered around the head of the operating table. The coaxial circuit was ventilated with either a modified Cape-Waine Mark 3 Ventilator or a Pneupac Ventilator (Adams and Henville, 1977) according to the principles described by Adams (1977).
J. SELWYN CRAWFORD
Birmingham REFERENCES
Gilston, A. (1977). S.I. Units. Br.J. Anaesth., 49, 394.
Sir,—In bemoaning the increasing use of S.I. units Dr Gilston (1977) may take comfort from the fact that he is not E. S. MACHELL alone. In the April edition of Construction News Magazine Southampton appears an article entitled "S.I.: it has to be" (Feilden, 1977). The first paragraph reads "Over the last year there REFERENCES have been a number of articles in technical magazines Adams, A. P. (1977). The Bain circuit. Anaesthesia, 32, 46. indicating a desperate rearguard action to counter the Henville, J. D. (1977). A new generation of anaesthetic inevitable spread and application of the International ventilators. The Pneupac and Penlon A-P. Anaesthesia, System of Units or S.I. for short." 32,34. A two-page article "The great measurement muddle" appeared elsewhere in the same Journal (Meadows, 1977). Henville, J. D., and Adams, A. P. (1976). A coaxial breathing circuit and scavenging valve. Anaesthesia, 31,257. The confusion resulting from the use of different systems of units in different parts of the World is as great in the Lippmann, M., and Mok, M. S. (1977). Tracheal cylindroma: anaesthetic management. Br.J. Anaesth., 49, 383. construction industry as it is in our own profession. A. G. HAMILTON
Reading
Sir,—We would like to answer Dr Machell's letter as follows. REFERENCES Figure 2 represents an array of endotracheal tubes, Feilden, G. B. R. (1977). S.I.: it has to be. Construction including a Carlen's double-lumen tube, which we designed specially for this patient in anticipation of complications News Magazine, 3,5. that might have taken place either on initial intubation or Gilston, A. (1977). S.I. units. Br.J. Anaesth., 49,394. Meadows, E. (1977). The great measurement muddle. during the operation itself. It was initially thought that a Carlen's tube might work, but after viewing the lesion via Construction News Magazine, 3,46.
Downloaded from http://bja.oxfordjournals.org/ at University of Ulster on June 28, 2015
S.I. UNITS
Sir,—I write to express wholehearted support for Dr Alan Gilston's plea (Gilston, 1977), and am not impressed by your own prevarication in the matter. As far as I can gather, apart from ourselves the only countries which have been subjected to authoritative implementation of the innovation are Australia and Denmark. Even in France, where the whole business was started, presumably, the Systeme has not been put to practical use. If an engineer and a biologist wish to communicate on a matter of common scientific interest, doubtless each would have sufficient intelligence to be able to appreciate the terminology used by the other, without recourse to an artificially standardized common nomenclature. Language poses what is probably the greatest barrier to the dissemination of information, and although many journals, including your own, have adopted the admirable system of presenting a summary of each original paper published in a selection of languages I have yet to learn of a move to legislate that all contributions to scientific journals be written in Esperanto. If we pursue this folly we shall place upon our current trainees and their successors the burden of furnishing themselves with a conversion table to be consulted each time they read a journal or a textbook published in North America or elsewhere. Do, please, have the courage of the convictions implicit in your reply to Dr Gilston, and by example lead an Editorial rejection of this most unpopular monstrosity.