European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
The influence of sufentanil and/or clonidine on the duration of analgesia after a caudal block for hypospadias repair surgery in children.
The aim of this study was to evaluate whether the addition of clonidine, or sufentanil, or both, to a bupivacaine solution for a caudal block prolonged the period of analgesia after operation in children. Sixty ASA class I or II boys, aged between 8 months and 13 years, admitted for hypospadias repair were enrolled into a prospective randomised study. After induction of general anaesthesia and endotracheal intubation the children were allocated into four groups. ⋯ All groups had a similar frequency of vomiting and a comparable appetite and quality of night rest during the first 24 h following the operation. There was no significant difference in the requirement for additional doses of analgesics. The addition of sufentanil, or clonidine, or both, to bupivacaine for caudal administration provides no additional clinical benefit over bupivacaine alone.
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Clinical Trial
Modification of the Penlon Nuffield 200 series ventilator and IPPV with a laryngeal mask airway.
There is a risk of regurgitation if a laryngeal mask airway is used with intermittent positive pressure ventilation. The lower the pressure gradient between airway and stomach, the less will be the likelihood of stomach insufflation with gas and consequent regurgitation. ⋯ At equal tidal volumes, the venturi modification provided a 10% lower inflation pressure (standard deviation 6%, P < 0.01) and a 1.8% smaller leak (P < 0.05) past the laryngeal mask airway. The same comparison but using identical inflation pressures, gave 8% larger tidal volumes (standard deviation 5.1%, P < 0.01) and a 2% smaller leak (P < 0.01) past the laryngeal mask airway.
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The concentrations of nitrous oxide, sevoflurane and oxygen in the circle system of a closed-circuit anaesthesia machine, the PhysioFlex, were measured in seven patients. During anaesthesia, the settings for each gas were changed and their concentrations recorded. At the induction of anaesthesia, it took 80-510s (median 190s) for the end-tidal sevoflurane concentration to reach 2.0%, and 920-2640s (median 1500s) for the oxygen in the breathing circuit to reach 30%. ⋯ When the inspired oxygen was increased from 30 to 50%, circuit concentrations reached equilibrium in 40-60s (median 40s), and when decreased from 50% back to 30%, equilibrium took 310-470s (median 450s). During recovery from anaesthesia, inspiratory sevoflurane concentration took 40-70s (median 50s) to decrease to 0.2%. The PhysioFlex provided adequate control of sevoflurane and oxygen concentrations, but not of increasing nitrous oxide concentrations.
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Despite a plethora of findings associated with the pathophysiology of malignant hyperthermia (MH), the in vitro contracture test (IVCT) is the only reliable test for diagnosis of this heterogeneous syndrome in man. An increase of 1,4,5-IP3 (inositol 1,4,5-trisphosphate), a second messenger involved in cellular calcium homeostasis, has been observed in muscle tissue of MH susceptible (MHS) patients. The aim of this study was to evaluate if the known differences of 1,4,5-IP3 content in muscle tissue might be reproduced in mononucleated white blood cells (MWBCs). ⋯ We conclude from our data that the detection of 1,4,5-IP3 synthesis in MWBCs is not suitable for diagnosis of MH disposition. It remains questionable whether an altered 1,4,5-IP3 metabolism in MWBCs is involved in pathologic cascades of MH. Therefore, other cell tissues should be evaluated in further studies to clarify the role of the 1,4,5-IP3 metabolism in MH.