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> I would also agree with RC Goat. Although TIVA is getting more popular > (e.g. > my anaesthetist brother hasn't used volatile anaesthetics for over two > years!), it is still not considered routine by most anaesthetists. > Volatile > agents also have a role in the management of bronchospasm in status > asthmaticus. The ventilation characteristics of an oxylog are rather > primitive, and especially when it comes to the asthmatics you will need > fine > tuning of I/E ratios, waveforms and PEEP etc. Of course a Boyles 'n' > Blease > can't do any of this, but emergency departments should be seen as > critical > care areas, and on that basis we should have ready access to as > sophisticated monitoring and ventilation equipment as found on intensive > care units. On with the revolution! Quite. I must declare an interest with eight years of anaesthesia behind me, and the knowledge of how essential these things can be. I quite agree about the crudity of oxylogs; fine for a few minutes on the transfer trolley but otherwise just too unrefined. The modern view of emergency care is that if the patient does not survive the first port of call in the Hospital there is little point in having the rest of the place. So the equipment needs to be at least of the capability of the ITU. Already, we have had several patients ventilated for 3 or 4 hours awaiting transfer to some other place, and while propofol infusions coupled with analgesia are fine, the ability to control oxygen and air ratios accurately (the function of the rotameters) is at least as important as the ability to give variable proportions of nitrous oxide. Equally, a patient with a head injury will benefit from the option to have isoflurane or sevoflurane administered. I think it is very important that if you are considering removing an anaesthetic facility (the concept of the Boyle's machine is no longer used) you should ensure you have taken soundings with your colleagues to understand the consequences. I was strongly supported by the anaesthetists here that they wanted the equipment around - cost per unit was only a couple of thousand pounds. Best wishes, Rowley Cottingham [log in to unmask] http://www.emergencyunit.com