Anaesthesia
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The uptake of isoflurane at a constant end-expired concentration of 1.5% in oxygen was studied in 15 women, ASA 1 or 2, undergoing elective total abdominal hysterectomy. The anaesthetic was administered by a simple computer-controlled to-and-fro closed system. ⋯ Perturbations from this bi-exponential decline reflect changes in cardiac output. The mean (SD) cumulative use of isoflurane was 4.5 (0.43) ml after 30 min and 7.3 (0.79) ml after 60 min.
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Comparative Study
A comparison of keyed and non-keyed vaporizer filling modes and volatile agent wastage.
Two hundred and forty bottles of enflurane were collected after their contents had been emptied into vaporizers equipped with keyed or non-keyed filling ports. The volume of agent remaining, the residual volume, was measured. There was a greater (p < 0.001) residual volume in 'empty' bottles which had been used to fill keyed compared with non-keyed enflurane vaporizers. ⋯ There was no significant difference between the residual volume remaining in bottles of isoflurane and enflurane used to fill keyed fillers; however, the difference was statistically significant if the residual volume was expressed as a proportion to the volume of agent contained in the full bottle. The results show that volatile anaesthetic agent wastage is increased by the use of keyed fillers. Isoflurane wastage caused by utilisation of keyed fillers could be reduced by a factor of 2.5 by supplying isoflurane in 250 ml rather than 100 ml bottles.
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Three portable suction devices were evaluated and compared with a wall-mounted vacuum driven suction unit. The Repro-med Res-Q-Vac, the Dräger Sujector 2000 and the Laerdal suction unit were assessed by measuring the time taken to aspirate 140 ml of mock gastric contents. ⋯ These compare favourable with the Ohmeda suction unit (7.27 (6.2-8.9)). Each type of device has advantages and disadvantages when factors such as size, power supply and portability are considered, and each will be the most suitable for a particular situation.
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Twenty-five patients underwent epidural anaesthesia with a new formulation of chloroprocaine 3% (1.0-1.5 ml x 10 cm body height-1) for a variety of day procedures. The mean (range) duration of surgery was 17 (5-35) min. ⋯ Two patients complained of severe backache immediately after operation and a further 16 and four patients reported mild or moderate backache respectively. Operating conditions were excellent in all but one patient and 23 patients said they would be happy to have the same anaesthetic again.
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The case notes and anaesthetic charts of 44 patients with dystrophic epidermolysis bullosa were reviewed retrospectively. A total of 390 general anaesthetics were performed for 469 surgical procedures over a 10-year period. Procedures included repair of syndactyly, dilatation of oesophageal strictures, extraction of teeth, excision of skin tumours and other procedures related to dystrophic epidermolysis bullosa. ⋯ Previous reports have suggested problems with the use of suxamethonium, nondepolarising muscle relaxants and thiopentone. These agents were all used in many of our patients without any adverse effects. There was one intra-operative death in a 35-year-old woman having an oesophageal dilatation which was complicated by oesophageal rupture.