Anaesthesia
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Clinical Trial Controlled Clinical Trial
No effect of circulating drug upon isolated forearm block.
Controversy exists as to whether the recovery of isolated arm blockade is primarily determined by resultant plasma drug concentrations, or by the affinity of the drug for the biophase. We have investigated the effect of the circulating drug produced by the isolated forearm experiment upon its recovery profile. Paralysis from retrograde spread of drug after the intravenous injection of 20 ml saline containing vecuronium 0.3 mg into a forearm isolated from the circulation was achieved in three groups of five experiments. ⋯ The mean (SD) 25% to 75% recovery indices of groups 1, 2 and 3 were: 9.2 (2.4), 8.7 (1.2) and 9.9 (1.9) min. There was no noticeable effect on the recovery slope of any of the traces when the second dose of myoneural blocker was given systemically in groups 2 and 3. The findings indicate that the main determinant of recovery of the isolated forearm experiment is not its plasma drug concentration but a mechanism which maintains the drug in the effect compartment.
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Comparative Study
Comparison of propofol and fentanyl anaesthesia in coronary artery versus valve surgery.
Total intravenous anaesthesia with propofol and fentanyl was used in 23 patients undergoing coronary artery and 16 patients undergoing valve surgery and the haemodynamic effects in the two groups were compared. Baseline values showed that the valve surgery group had a higher mean heart rate, pulmonary artery wedge pressure and pulmonary artery pressure and smaller mean stroke volume than the coronary artery surgery group. ⋯ In the valve surgery group there were greater percentage decreases in heart rate, mean arterial pressure and diastolic arterial pressure. Overall, propofol and moderate-dose fentanyl anaesthesia was no more detrimental to the haemodynamics in patients undergoing valve surgery when compared to those undergoing coronary artery surgery.
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A patient undergoing pharyngo-oesphagectomy with gastric transposition sustained a large tracheal tear during the blind oesophageal dissection. High frequency jet ventilation was successfully employed in the acute airway management and continued postoperatively.
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Two patients with respiratory distress are described in which the laryngeal mask airway and continuous positive airway pressure were used with good effect. The laryngeal mask airway may be useful in some cases of respiratory distress occurring in the intensive care unit when a patient is unable to tolerate a tracheal tube.
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Case Reports
Fatal subclavian artery haemorrhage. A complication of subclavian vein catheterisation.
Subclavian artery puncture occurred during attempted subclavian vein catheterisation. Although initially stable, the patient became shocked one day later and died from massive local haemorrhage. This case emphasises the need for continued vigilance following accidental arterial puncture.