European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Volume replacement with gelatin or hydroxyethylstarch solutions does not impair somatosensory evoked potential monitoring: a haemodilution study in conscious volunteers.
The influence of haemodilution with colloids on somatosensory evoked potentials in non-premedicated volunteers is reported. In seven volunteers (randomized crossover design), blood (20 mL kg-1 within 30 min) was removed and simultaneously replaced by gelatin 3% or hydroxyethylstarch 6%. After 30 min, blood was retransfused within 30 min. ⋯ Retransfusion increased haematocrit to 34.4 +/- 0.9% (gelatin) and to 34.2 +/- 1.3% (hydroxyethylstarch). Neither haemodilution with gelatin nor haemodilution with hydroxyethylstarch or retransfusion influenced evoked potentials. In conclusion, the treatment of blood loss up to 30% of estimated blood volume with gelatin or hydroxyethylstarch will not affect somatosensory evoked potential monitoring provided normovolaemic conditions are maintained.
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The facial nerve is monitored intra-operatively using electromyography to identify and prevent damage during the excision of an acoustic neurinoma. In order to determine whether a profound level of peripheral neuromuscular blockade could be achieved without compromising facial electromyographic monitoring, 11 patients undergoing resection of acoustic neurinoma were studied. ⋯ The facial nerve was directly stimulated in the surgical field and the facial evoked muscle potentials (EMPs) were recorded. Even under complete peripheral neuromuscular blockade (i.e. no electrically evoked muscle potential measurable over the hypothenar eminence, no palpable hypothenar muscle response) it was possible to evoke facial muscle electromyographic responses by stimulation of the facial nerve.
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There has been controversy over whether forward blood flow during closed-chest cardiopulmonary resuscitation (CPR) is generated by a general increase in intrathoracic pressure (chest-pump theory) or by creating atrioventricular gradients that close the mitral valve and open the aortic valve during thoracic compression (cardiac pump theory). The crucial issue is the position of the mitral valve during the downstroke of chest movement. Questions remain over the actual mechanics of mitral and aortic valve function. This report describes an intraoperative cardiac arrest followed by CPR during which routinely instituted two-dimensional transoesophageal Doppler echocardiography enabled study of the motion of the valves of the left heart and the transmitral blood flow.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron and metoclopramide for the prevention of post-operative nausea and vomiting after major gynaecological surgery.
The efficacy of ondansetron 4 mg was compared with metoclopramide 10 mg for the prevention of post-operative nausea and vomiting in patients after major gynaecological abdominal surgery. Anaesthesia was standardized using thiopentone, atracurium and methadone for induction followed by isoflurane in nitrous oxide-oxygen mixture. Fifty patients were randomized in a double-blind fashion to either receive intravenous (i.v.) ondansetron 4 mg or metoclopramide 10 mg during closure of the pelvic peritoneum. ⋯ The highest incidence of nausea was in the first 4 h after surgery, being 56 and 37.5% in the ondansetron and the metoclopramide groups respectively. This decreased to less than 25% in both groups in the 12-24 h period. Ondansetron 4 mg and metoclopramide 10 mg had similar but short lasting efficacy for the prevention of vomiting in patients who received continued opioid analgesia after major gynaecological surgery.
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This study was designed to investigate whether the advantages of low- and minimal-flow anaesthesia can be combined with the laryngeal mask airway (LMA). Seventy female patients undergoing routine gynaecological surgery were investigated. After induction of anaesthesia and after positioning a laryngeal mask airway nos 3 and 4, patients were ventilated for 20 min with a fresh gas flow of 6 L min-1. ⋯ It is concluded, that the application of low-flow and even minimal-flow anaesthesia is an alternative to high-flow anaesthesia. It can result in high annual savings and minimization of pollution. However, its use should be restricted to those anaesthesiologists who are experienced with the laryngeal mask airway and minimal-flow anaesthesia.