Anaesthesia
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Spinal anaesthesia should not be performed above the L3/4 interspace if relying on surface anatomy to determine spinal level.
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Multicenter Study Clinical Trial
The safety and efficacy of cisatracurium 0.15 mg.kg(-1) during nitrous oxide-opioid anaesthesia in infants and children.
We studied the neuromuscular and cardiovascular effects of a single, rapidly administered intravenous dose of cisatracurium 0.15 mg.kg(-1) in 27 infants (aged 1-23 months) and 24 children (aged 2-12.5 years). After midazolam premedication, anaesthesia was induced and maintained with thiopental and alfentanil in addition to nitrous oxide in oxygen. Neuromuscular function was monitored by evoked adductor pollicis electromyography. ⋯ Once neuromuscular function started to recover, the rate of recovery was similar in both age groups. Changes in blood pressure and heart rate after the administration of cisatracurium were negligible in both age groups. Cisatracurium, at a dose of 0.15 mg. kg(-1), was effective and well tolerated in infants and children.
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Comparative Study
The effects of syringe plunger design on drug delivery during vertical displacement of syringe pumps.
Fluid delivery from four types of commercially available 50-ml syringes was measured using an electronic balance at an infusion rate of 1 ml.h(-1). Retrograde aspiration volume and zero-drug delivery time were recorded after lowering the syringe pump by 50 cm. Syringe compliance was calculated from the volume of bolus released after occlusion at 100 mmHg. ⋯ Syringe design affected the internal syringe compliance. All syringes were associated with potentially relevant zero-drug delivery times after moderate vertical displacement. To minimise this risk, vertical displacement of syringe pumps delivering highly vasoactive drugs should be avoided.
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Randomized Controlled Trial Comparative Study Clinical Trial
Learning fibreoptic endoscopy. Nasotracheal or orotracheal intubations first?
We have studied the extent to which learning fibreoptic nasotracheal endoscopy first helped anaesthetists to learn fibreoptic orotracheal endoscopy later, and vice versa. After preliminary training on a bronchial tree model, 30 anaesthetic trainees were randomly allocated to the nasal first/oral second group, who performed 10 nasal intubations followed by 10 oral intubations, or the oral first/nasal second group, who performed 10 oral intubations followed by 10 nasal intubations, in anaesthetised, ASA group I or II patients undergoing elective oral or general surgery. ⋯ The mean (SD) total endoscopy time for all the endoscopies (both nasal and oral) in the nasal first/oral second group [1196 (162) s] was not significantly different from that for all the endoscopies in the oral first/nasal second group [1193 (188) s]. Because there is no advantage or disadvantage to be gained in starting to learn either type of endoscopy first, graduated training programmes can be planned according to the availability of suitable patients for fibreoptic intubation, without instructors needing to consider whether trainees make better progress if they learn one technique before the other.