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STOPPAGE OF BREATHING DUE TO LARYNGEAL SPASM
CORRESPONDENCE To the Editor of the British Journal of Ancesthesia. STOPPAGE OF BREATHING DUE TO LARYNGEAL SPASM. Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on June 14, 2015
Dear Sir,—In a recent number you suggested that anaesthetists might discuss anaesthetic deaths in the journal. During the past year I have had four cases which have not been very successful. (i). A man aged 75; operation, prostatectomy. An attempt was made by the surgeon to administer a spinal anaesthetic, but the patient had very marked arthritis of his spine and the spinal anaesthetic was not successful, so I was asked to administer an inhalation anaesthetic. I gave the patient gas-oxygen-ether from a Boyle's apparatus and no trouble was experienced during the induction. When the surgeon passed his finger into the bladder to remove the prostate, however, the patient developed severe laryngeal spasm and stopped breathing. Artificial respiration was tried, but without avail, and the patient's condition became extremely grave. An endotracheal tube was then introduced and oxygen administered through this. The patient's condition failed to improve and cardiac massage was started. The patient gradually recovered, but died twenty-four hours later without recovering consciousness. (2). A man aged 86, with acute retention of the urine. He was a very ill man on admission, and gas and oxygen was administered with a view to suprapubic puncture. Immediately this was done the patient stopped breathing, due to laryngeal spasm. Artificial respiration again failed, and then an endotracheal tube was passed with some difficulty and oxygen administered. The patient gradually recovered, but died the next day. He was found to have a large carcinoma of the bladder.
Correspondence
131
To the Editor of the British Journal of Ancesthesia. UNIFORMITY IN APPARATUS.
Dear Sir,—Our attention has been drawn to your correspondent's letter on the subject of "Uniformity in Apparatus", and we should like to bring to your notice the fact that we have, for some months, been in the habit of using the following coloured rubber tubings for connexions to gas cylinder valves;
Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on June 14, 2015
(3). A man aged 75, admitted with acute retention of the urine. Gas and oxygen was administered for suprapubic drainage. The patient stopped breathing when the bladder was opened, and only recovered after the introduction of an endotracheal tube and the administration of oxygen. The patient made good recovery. (4). A man aged 75, suffering from an obstructed umbilical hernia. Gas and oxygen was administered, and after about five minutes the patient stopped breathing; once more in spasm. An endotracheal tube was introduced and oxygen administered, but the patient was only with difficulty induced to breathe again. The operation was completed and the patient recovered. Now there was a marked resemblance between all these patients. All were elderly men, all were of the large, heavy, red-faced type, all had bushy eyebrows and large moustaches, all had hard, rigid chests which made artificial resspiration almost impossible. All four patients stopped breathing for apparently the same cause—laryngeal spasm, and they stopped breathing to a degree which gave cause of very serious alarm. As a general practitioner anaesthetist I should be infinitely obliged if some anaesthetist of wide experience would tell me how to overcome these difficulties, or how to avoid them in future. Yours faithfully, G.P.
Dear Sir,—In a recent number you suggested that anaesthetists might discuss anaesthetic deaths in the journal. During the past year I have had four cases which have not been very successful. (i). A man aged 75; operation, prostatectomy. An attempt was made by the surgeon to administer a spinal anaesthetic, but the patient had very marked arthritis of his spine and the spinal anaesthetic was not successful, so I was asked to administer an inhalation anaesthetic. I gave the patient gas-oxygen-ether from a Boyle's apparatus and no trouble was experienced during the induction. When the surgeon passed his finger into the bladder to remove the prostate, however, the patient developed severe laryngeal spasm and stopped breathing. Artificial respiration was tried, but without avail, and the patient's condition became extremely grave. An endotracheal tube was then introduced and oxygen administered through this. The patient's condition failed to improve and cardiac massage was started. The patient gradually recovered, but died twenty-four hours later without recovering consciousness. (2). A man aged 86, with acute retention of the urine. He was a very ill man on admission, and gas and oxygen was administered with a view to suprapubic puncture. Immediately this was done the patient stopped breathing, due to laryngeal spasm. Artificial respiration again failed, and then an endotracheal tube was passed with some difficulty and oxygen administered. The patient gradually recovered, but died the next day. He was found to have a large carcinoma of the bladder.
Correspondence
131
To the Editor of the British Journal of Ancesthesia. UNIFORMITY IN APPARATUS.
Dear Sir,—Our attention has been drawn to your correspondent's letter on the subject of "Uniformity in Apparatus", and we should like to bring to your notice the fact that we have, for some months, been in the habit of using the following coloured rubber tubings for connexions to gas cylinder valves;
Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on June 14, 2015
(3). A man aged 75, admitted with acute retention of the urine. Gas and oxygen was administered for suprapubic drainage. The patient stopped breathing when the bladder was opened, and only recovered after the introduction of an endotracheal tube and the administration of oxygen. The patient made good recovery. (4). A man aged 75, suffering from an obstructed umbilical hernia. Gas and oxygen was administered, and after about five minutes the patient stopped breathing; once more in spasm. An endotracheal tube was introduced and oxygen administered, but the patient was only with difficulty induced to breathe again. The operation was completed and the patient recovered. Now there was a marked resemblance between all these patients. All were elderly men, all were of the large, heavy, red-faced type, all had bushy eyebrows and large moustaches, all had hard, rigid chests which made artificial resspiration almost impossible. All four patients stopped breathing for apparently the same cause—laryngeal spasm, and they stopped breathing to a degree which gave cause of very serious alarm. As a general practitioner anaesthetist I should be infinitely obliged if some anaesthetist of wide experience would tell me how to overcome these difficulties, or how to avoid them in future. Yours faithfully, G.P.