Anaesthesia
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Clinical Trial Controlled Clinical Trial
Sensitivity to second dose of mivacurium.
The sensitivity of patients to a second dose of mivacurium has been studied following complete recovery of the twitch response after > 95% neuromuscular block produced by a systemic bolus of the drug. In further experiments we have excluded one arm from the effect of a systemic bolus ED95 dose of mivacurium for 100 s so as to obtain two different levels of neuromuscular block in the two arms of the same patient. ⋯ A similar increase in sensitivity was observed in the arm that had been excluded for 100 s from the peak effect of the drug. It was concluded that the second dose sensitivity was not due to a receptor effect or to residual drug in plasma.
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A previously fit 20-year-old man presented with a large haemothorax following a stab wound to the left chest. Pre-operative airway assessment indicated that tracheal intubation would be routine. ⋯ At operation, the patient's common carotid artery was found to have been perforated close to its origin on the aorta. The patient made an uneventful recovery.
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This observational study examined whether specific characteristics of 1168 patients admitted to a general intensive therapy unit had changed over 4 years. The patients' age, diagnosis, severity of illness on admission (APACHE score), duration of management and outcome were recorded prospectively. The risk of hospital mortality was calculated using the APACHE score modified by the appropriate coefficient for presenting diagnosis. ⋯ There was a significant reduction in duration of admission with 70% of patients being admitted for < or = 3 days in 1988-89 while a similar proportion were admitted for a week in 1985-86. Approximately 40% of patients in each year were admitted with a risk of hospital mortality of < or = 10%; such patients received only a short period of intensive care and had a low mortality in the intensive therapy unit. A group of patients with a low predicted (and actual) mortality rate was identified; such patients may be more appropriately managed on a high dependency unit.
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In developing countries like Nepal, anaesthetic compressed gases, especially nitrous oxide, are expensive and in short supply and anaesthetic techniques must equally use oxygen and volatile anaesthetics sparingly. We have designed a non-rebreathing anaesthetic system which meets these requirements. An Ambu-E anaesthetic valve and self-inflating Ambu bag connected to a Bain system form a non-rebreathing system which uses ambient air to supplement a mixture of low flow oxygen and halothane. ⋯ A graphical analysis of gas flow predicts that the system is almost 100% efficient, in that almost all of the oxygen and halothane will enter the alveoli. Our experience confirms that this is a safe, simple and economical method for inhalation anaesthesia. We recommend it for locations where anaesthetic machines and mechanical ventilators are lacking, and where medical oxygen is in short supply.
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Case Reports
Emergency intubation through the laryngeal mask airway. The effective application of cricoid pressure.
A patient with Kugelberg-Welander disease presented as an unexpected difficult intubation. Tracheal intubation was achieved through the laryngeal mask airway, while regurgitation was prevented with continuous cricoid pressure. Regurgitation occurred after cricoid pressure was released.