Anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
A new gas jet method for the assessment of sensory block after spinal anaesthesia.
We evaluated a new method of assessing sensory block after spinal anaesthesia using a fine gas jet and compared it with other established methods. The gas jet method was used to test the block before and after surgery and was found to compare favourably with pin-prick (median difference 0 and 0 dermatomes) and ethyl chloride (median difference 0.5 and 1.0 dermatomes) but less well with cotton wool (median difference -2.0 and -2.0 dermatomes).
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A Combitube airway was inserted into 40 patients undergoing general anaesthesia. A rigid cervical collar was then used to immobilise the neck of each patient. ⋯ In 18/40 patients (45%), blood was present on the Combitube after removal. Reducing the volume of air injected into the proximal balloon of the Combitube appeared to reduce the incidence of airway trauma during insertion.
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We have assessed the practicality and performance of the Vital Signs Paragraph neuromuscular blockade monitor as part of a 'self-learning' fuzzy logic control feedback system used to administer atracurium to a required depth of neuromuscular blockade. Fifteen patients undergoing surgery expected to last longer than 90 min entered the study. A Vital Signs Paragraph was used to measure the degree of neuromuscular blockade and control it such that the first twitch of the train-of-four was kept at 10% of its baseline value. ⋯ The mean atracurium infusion rate ranged from 0.13 to 0.67 mg.kg-1.h-1. These results compare reasonably well with previous results using the Datex Relaxograph, whilst the system itself was portable and easy to use. However, the reliability of the system was limited due to variability in the sensitivity of piezoelectric sensors.
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Critical care services appear to face increasing demand. To attempt to identify factors which may predispose to such increases in demand, the patients and their treatment were reviewed. The patients' ages, referring specialty and their risk of hospital mortality were recorded on admission. ⋯ The patients' mean ages increased by 1 year per year. The number of patients referred from general surgery consistently increased. The proportion of patients receiving vasoactive drugs and pulmonary artery catheters declined as did the duration of respiratory and renal support.
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Case Reports
Regional anaesthesia with a subarachnoid microcatheter for caesarean section in a parturient with aortic stenosis.
We present a woman in her first pregnancy, with known aortic stenosis prior to conception, who successfully underwent regional anaesthesia for an elective Caesarean section using a subarachnoid microcatheter. The anaesthetic management of patients with aortic stenosis requiring noncardiac surgery is a complex and contentious matter, particularly when the situation is compounded by the physiological changes accompanying pregnancy and delivery. This is the first reported use of a subarachnoid microcatheter in such a patient. The choice of technique is discussed and compared with other options for providing anaesthesia.