Anaesthesia
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Clinical Trial Controlled Clinical Trial
Evaluation of the use of the Flexiblade.
The Flexiblade is a laryngoscope which has a 'flexible' blade. The 'front' half of the blade can be moved in an anterior direction during laryngoscopy, enhancing the view of the glottis. The degree of movement can be controlled with the lever. ⋯ Ninety-seven per cent of patients with a Cormack and Lehane grading of 2 at normal laryngoscopy were transformed to grade 1 when the lever of the Flexiblade was depressed and 84% of cases with a grading of 3 were transformed to grade 2 or 1. In four patients, there was deterioration in the view of the cords: three patients with grade 1 were transformed to grade 2 and one with grade 2 to grade 3. There was no improvement in one case with grade 2 and three with grade 3.
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Two case histories of pregnant women with Guillain Barré syndrome (acute demyelinating polyradiculoneuritis) are reported. The first required anaesthesia during the second trimester for a minor surgical procedure. ⋯ A review of the management of Guillain Barré syndrome in pregnancy discusses anaesthetic management, intensive care and the use of plasmapheresis and gamma-globulins. The care of pregnant women recovered from Guillain Barré syndrome is also discussed.
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Epinephrine and sodium bicarbonate may be added to local anaesthetic solutions in order to reduce the onset time and enhance the quality of epidural anaesthesia for Caesarean section. Such mixtures are sometimes prepared several hours in advance for subsequent use in emergency Caesarean section through a pre-existing epidural catheter. ⋯ Bupivacaine and lidocaine concentrations in all mixtures did not decrease over time regardless of alkalinisation. We do not recommend adding epinephrine to alkalinised epidural solutions that are to be stored for a prolonged period before clinical use.
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We hypothetised that the rate of pre-oxygenation could be altered by the increase in lung volume and airflow obstruction observed in emphysema. End-tidal oxygen concentration was monitored, using a paramagnetic oxygen analyser, during 10-min pre-oxygenation (tidal breathing of 100% oxygen) in 10 normal patients and in 10 patients with severe diffuse emphysema documented by computerised tomography. Emphysema was characterised by an important increase in functional residual capacity of the lungs [190 (23)% of predicted values] and a decrease in expiratory flow. ⋯ After 3 and 5 min of pre-oxygenation, the end-tidal fractional oxygen concentration was significantly lower in the emphysema group than the control group [mean (SD); value at 3 min: emphysema: 0.83 (0.06) vs. control: 0.91 (0.02), p = 0.0005]. Individual values of end-tidal oxygen concentration measured after 3, 5 and 10 min of pre-oxygenation were negatively correlated with functional residual capacity in the emphysema group, whereas no such correlation was found in the control group. These results suggest that pre-oxygenation should be monitored in patients with diffuse emphysema to ensure that adequate pre-oxygenation is achieved.