Anaesthesia
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Case Reports
A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah's Witness.
Blood volume was maintained by an infusion of hydroxyethyl starch 2000 ml (Hespan: HES) during and for the first 28 hours after a major orthopaedic operation in a 13-year-old girl who was a Jehovah's Witness. This was responsible for a generalised clinical haemorrhagic state, an acquired coagulopathy associated with a shortened thrombin, prolonged prothrombin and activated partial thromboplastin times, and an acquired von Willebrand syndrome. The coagulation, after cessation of the infusion of HES, did not become normal until approximately 72 hours later.
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A case of malignant hyperthermia in a small child with a chromosomal abnormality is described. The management of malignant hyperthermia in very small children is discussed.
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Comparative Study
A comparison of different methods of lubrication of glass syringes used to identify the epidural space.
Measurement of loss of resistance in glass syringes is a method widely used to locate the epidural space in epidural anaesthesia. Static and dynamic forces were measured under four experimental conditions in new glass syringes: unpolished, dry; polished, dry; unpolished, saline lubricated; and polished, saline lubricated. ⋯ These values were significantly greater than for polished dry syringes where the values were 5.27 (2.1) g and 4.38 (0.94) g, respectively. The results show that the least amount of resistance to plunger movement is obtained by dry polishing glass syringes.
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This paper considers cardiopulmonary resuscitation in obstetric patients at term and the influence of aortocaval compression on the outcome. The maximum chest compression force produced by eight physicians was measured as a function of angle of inclination using an inclined plane. The compression force at an angle of 27 degrees is 80% of that in the supine position and the Cardiff resuscitation wedge, designed to prevent aortocaval compression, is described with this inclination. ⋯ The majority had acquired errors in external chest compression and mouth to mouth ventilation. These were corrected by additional tuition. Resuscitation of the manikin on the Cardiff wedge was found to be as efficient as in the supine position.