Read e-book online Complete Textbook of Anaesthesia and Intensive Care Medicine PDF

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Sample text

The needle should be passed along the superior border of the rib to avoid the neurovascular bundle. There is a risk of penetrating the diaphragm if aspiration is attempted below the seventh intercostal space. Anaesthesia Local anaesthesia of intercostal nerves has an important role to play in managing the pain arising from fractured ribs or reducing the pain of a thoracotomy. The appropriate nerve and the two nerves above and below (because of the overlapping supply) are infiltrated at or around the rib angle.

The ECG may be distorted during cardiac displacement; in particular, the amplitude and ST segment changes may be reduced. ST segment trending is useful. Pulmonary artery pressure monitoring and transoesophageal echocardiography (TOE) may be used in high-risk patients with severe left ventricular dysfunction. TOE is useful in the detection of regional wall motion abnormalities and thus early ischaemic changes. During OPCAB, the heart is displaced or lifted and standard TOE views are lost. Furthermore, the stabilizers used may produce artefacts of regional wall motion abnormalities.

The left bronchus is about 5 cm long. Anteriorly, the left pulmonary artery separates it from the left atrium. The arch of the aorta is above it and posteriorly the bronchial vessels separate it from the oesophagus and the thoracic aorta. u Copyright © 2003 The Medicine Publishing Company Ltd The Veins of the Lower Limb John Craven John Craven was formerly Consultant Surgeon at York District Hospital, York, UK. He trained in Manchester, Uganda and Cardiff. He is past chairman of the primary examiners of the Royal College of Surgeons of England.

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