Anaesthesia
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Pressure-sensitive ventilator disconnexion alarms do not always alarm during disconnexion of a discharging compliance ventilator such as Manley Blease, unless accurately adjusted. High flows during disconnexion result in significant pressure generation caused by outflow resistance of catheter mounts, heat and moisture exchangers, capnometer cuvettes, and angled connectors; this may lead to alarm failure because of incorrectly adjusted pressure alarm limits. The exact position of the disconnexion is critical and if the alarm's pressure sensor is placed in either the inspiratory or expiratory limb of the ventilator it makes no difference to its correct function. ⋯ Those with 15-mm male connectors generate the highest pressures on disconnexion (1.1 kPa). It is suggested that the low pressure alarm limit is set only marginally below the peak inspiratory pressure, and that it is readjusted for every patient and after every change in ventilation. Most importantly, the alarm should be shown to be functional by a trial disconnexion at the tracheal tube.
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Randomized Controlled Trial Clinical Trial
Alfentanil used to supplement propofol infusions for oesophagoscopy and bronchoscopy.
This randomised double-blinded study compared the cardiovascular stability and rate of recovery when propofol infusions with or without alfentanil were used to provide anaesthesia for rigid oesophagoscopy and (or) bronchoscopy. Forty-six patients were allocated randomly to receive either alfentanil 10 micrograms/kg or saline just before a rapid sequence induction with propofol. Suxamethonium 1 mg/kg was given and infusions of suxamethonium 10 mg/minute and propofol (10 mg/kg/hour for 10 minutes, 8 mg/kg/hour for 10 minutes and then 6 mg/kg/hour thereafter) were started. ⋯ Recovery from anaesthesia was assessed using the critical flicker fusion threshold. No differences were found between the groups and patients in both groups had returned to baseline values by 60 minutes. No patient had any recall of intra-operative events, and there were no other adverse effects of any significance.
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Comparative Study
Postoperative analgesia for haemorrhoidectomy. A comparison between caudal and local infiltration.
This study compared the analgesic effectiveness of local infiltration of bupivacaine with caudal extradural bupivacaine in the first 48 hours after haemorrhoidectomy. Surgical and anaesthetic protocol was rigidly standardised. ⋯ There was no significant difference between the two groups with respect to further analgesic requirements, complications, time to first bowel action, and duration of hospital stay. The definite advantage of caudal extradural bupivacaine for haemorrhoidectomy must be balanced against the rare but potentially serious complications associated with its use.
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Editorial Biography Historical Article
Professor Emeritus Sir Robert Reynolds Macintosh 17 October 1897-28 August 1989.