Anaesthesia
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We describe a series of patients in whom anaesthetists - many of whom were trainees and had no prior experience of using the Aintree Intubation Catheter - successfully intubated the tracheas of patients in whom conventional attempts at intubation had failed. This was achieved by passing a fibrescope loaded with an Aintree Intubation Catheter through a classic Laryngeal Mask Airway (cLMA), which had already been placed to maintain the patient's airway.
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Hospital-acquired infection is an increasing problem in intensive care units, where the patients are more susceptible and the organisms often more resistant than in other environments. This review discusses the reasons for these phenomena and describes the mechanisms underlying antibiotic resistance and the common intensive care unit-acquired organisms.
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Comparative Study
Correlation of EEG spectral entropy with regional cerebral blood flow during sevoflurane and propofol anaesthesia.
ENTROPY index monitoring, based on spectral entropy of the electroencephalogram, is a promising new method to measure the depth of anaesthesia. We examined the association between spectral entropy and regional cerebral blood flow in healthy subjects anaesthetised with 2%, 3% and 4% end-expiratory concentrations of sevoflurane and 7.6, 12.5 and 19.0 microg.ml(-1) plasma drug concentrations of propofol. ⋯ Midfrontal-central spectral entropy was associated with individual frontal and whole brain blood flow values across all conditions, suggesting that this novel measure of anaesthetic depth can depict global changes in neuronal activity induced by the drugs. The cortical areas of the most significant associations were remarkably similar for both drugs.
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The European Working Time Directive and the New Deal have decreased the number of hours worked by anaesthetic trainees. We implemented the Working Time Directive in May 2004 and evaluated the effect of its implementation on training. ⋯ Exposure to subspecialty lists was the same in both periods, but this was at the expense of general lists and those in remote locations. We conclude that the Working Time Directive has had a measurable impact on the training of paediatric anaesthetists, but that the significance of this change for clinical practice has not yet been measured.
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Case Reports
Transverse myelitis following general and epidural anaesthesia in a paediatric patient.
A 13-year-old girl developed transverse myelitis 2 weeks after an uncomplicated, combined general and epidural anaesthetic for orthopaedic surgery. Since epidural anaesthesia had been used, a causal relationship might have been assumed. We review the aetiology and pathogenesis of acute transverse myelitis and the role of anaesthesia in this disorder. Although a causal relationship cannot be assumed and regional anaesthesia in children is considered safe, we would like to re-emphasise the management principles and practices that may improve the benefit-to-risk ratio of these techniques.