Anaesthesia
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Lumbar epidurography with multi-orifice and single orifice epidural catheters.
The spread of iohexol in the epidural space was studied using two types of epidural catheter. Twenty pre-menopausal women undergoing hysterectomy received lumbar epidural analgesia via either multi-orifice or single orifice catheters. ⋯ Sacral spread of dye was only observed when a single orifice catheter was used. Epidural catheter design affects the distribution of solutions in the epidural space, with single orifice epidural catheters producing more even distribution of dye with sacral extension.
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Back pain and minor neurological symptoms are commonly experienced postpartum, often being attributed to non-specific causes such as maternal obstetric factors, or the use of epidural analgesia. We report a case in which neurological problems associated with a prolapsed intervertebral disc occurred after epidural analgesia in labour and a normal vaginal delivery.
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The changes occurring in total respiratory system, lung and chest wall mechanics, lung volume and gas-exchange during abdominal insufflation with carbon dioxide for laparoscopic cholecystectomy were studied. Using the technique of rapid airway occlusion during constant flow inflation together with an oesophageal balloon, we computed compliance and maximum resistance of the respiratory system, subsequently apportioning it into its lung and chest wall components. Maximum resistance of the respiratory system was further divided into airway resistance and the viscoelastic properties of the lung and the chest wall. ⋯ Tidal volume, respiratory rate, inspiratory flow and the fraction of inspired oxygen were similar in both groups and maintained constant during the procedure. We found that abdominal carbon dioxide insufflation caused: a reduction in compliance of the respiratory system (both lung and chest wall components) and of functional residual capacity; a marked increase in the maximum resistance of the respiratory system (mainly due to increases in the viscoelastic properties of the lung and chest wall); no change in oxygenation, but an increase in the end-tidal carbon dioxide tension (which was correlated closely with the arterial carbon dioxide tension). These changes were not affected by the duration of anaesthesia.
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Letter Case Reports
Airway obstruction due to arytenoid prolapse in two children.