Anaesthesia
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Randomized Controlled Trial
Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section.
We determined the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for Caesarean section. Ninety women were randomly allocated to two groups and received 3 ml of study solution by a combined spinal/epidural technique. The initial dose was 12 mg for levobupivacaine and 17 mg for ropivacaine groups. ⋯ Effective or ineffective responses determined, respectively, a 0.3 mg decrease or increase of the same drug for the next patient in the same group, using up-down sequential allocation. The MLAD of levobupivacaine was 10.58 mg (CI 95%: 10.08-11.09) and the MLAD of ropivacaine 14.22 mg (CI 95%: 13.67-14.77), using the Dixon and Massey formula. The potency ratio between spinal levobupivacaine and spinal ropivacaine was 1.34.
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Case Reports
Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus.
We report a patient, 33 weeks pregnant with twins, who sustained a ruptured splenic artery aneurysm. This presented with left sided chest pain, breathlessness, low oxygen saturations and electrocardiogram (ECG) changes supportive of a diagnosis of massive pulmonary embolus. The diagnosis of splenic artery rupture was made at emergency Caesarean section performed for fetal distress.
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Comparative Study
A comparison of two single dilator percutaneous tracheostomy sets: the Blue Rhino and the Ultraperc.
The single tapered dilator kit is the most commonly used percutaneous tracheostomy set in the UK. The Cook Blue Rhino and the Portex Ultraperc were compared in the laboratory on mannequin and porcine airway models. The following data were collected: the subjective ease of dilating the trachea and inserting the tracheostomy tube; the time taken and the anterior-posterior compression during dilatation and tube insertion; the incidence and extent of posterior tracheal wall damage. ⋯ There was no difference in the incidence of damage between the two sets. The Ultraperc therefore has advantages during tracheostomy tube insertion that are statistically and clinically significant. The advantages are probably due to the presence of the tracheostomy tube introducer.