European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children.
Situations may occur in anaesthetic practice where the use of neuromuscular blocking drugs is unsuitable or contraindicated. We investigated the use of propofol given 5 min after fentanyl to permit endotracheal intubation in children. ⋯ Propofol (3.0 mg kg(-1)) preceded by fentanyl (3.0 microg kg(-1)) was adequate for the induction of anaesthesia in children and provided adequate tracheal intubating conditions without significant haemodynamic changes. This method represents a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.
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Randomized Controlled Trial Clinical Trial
Optimizing peroperative compliance with PEEP during upper abdominal surgery: effects on perioperative oxygenation and complications in patients without preoperative cardiopulmonary dysfunction.
Late postoperative hypoxaemia after upper abdominal surgery is common even among cardiopulmonary healthy patients. Atelectasis may develop after intubation and persist into or reveal a disposition for atelectasis in the postoperative period. Positive end-expiratory pressure (PEEP) eliminates peroperative atelectasis but the effect on perioperative oxygenation is controversial. This study evaluated the effect of peroperative PEEP optimized pulmonary compliance on perioperative oxygenation and complications. ⋯ Peroperative arterial oxygenation improved for all patients receiving PEEP, mean 2.1 kPa (0.7-3.5 kPa). There was no difference in postoperative median PaO2 between the groups. The differences in the incidence of late prolonged postoperative hypoxaemia and complications were 25% (-5% to 55%) and -1% (-31% to 29%) between the ZEEP and the PEEP group, but were not statistically significant.
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A 51-year-old man presented with a right upper lobe adenocarcinoma with carinal extension. He underwent a right sleeve pneumonectomy, which involved a carinal resection with anastomosis between the trachea and left main bronchus. This report describes the successful use of jet ventilation, administered via the lumen of the bronchial blocker of a Univent tube. During 15 min of carinal resection, oxygenation of his left lung was maintained with the bronchial blocker bridging the airway discontinuity.
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Case Reports
Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism.
A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. ⋯ Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.
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Case Reports
Epidural anaesthesia for Caesarean section in a patient with von Hippel-Lindau disease.
Von Hippel-Lindau disease is a rare autosomal dominant disease with incomplete penetrance and variable expression and is characterized by diffuse haemangioblastomas of the central nervous system and viscera. The majority of the central nervous system lesions are located in the cerebellum. This report describes the successful management with epidural anaesthesia of a woman with a term gestation, von Hippel-Lindau disease and cerebellar haemangioblastoma.