Anaesthesia
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Randomized Controlled Trial Multicenter Study Comparative Study
Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium.
After repeated rocuronium administration there is wide inter-patient variability in the time to recover muscle function.
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Case Reports
Extracorporeal carbon dioxide removal using the Novalung in a patient with intracranial bleeding.
A neurosurgical patient who required repeated surgery for intracranial haematoma developed acute respiratory distress syndrome. Raised intracranial pressure proved difficult to manage whilst attempting to maintain optimal gas exchange. ⋯ Subsequently the requirements for both respiratory and cardiovascular support were reduced. The patient made a complete neurological recovery.
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We describe the use of a questionnaire to define the difficulties in providing anaesthesia in Uganda. The results show that 23% of anaesthetists have the facilities to deliver safe anaesthesia to an adult, 13% to deliver safe anaesthesia to a child and 6% to deliver safe anaesthesia for a Caesarean section. ⋯ Solutions require improvements in local management, finance and logistics, and action to ensure that the importance of anaesthesia within acute sector healthcare is fully recognised. Major investment in terms of personnel and equipment is required to modernise and improve the safety of anaesthesia for patients in Uganda.
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Randomized Controlled Trial
The effect of positive end expiratory pressure on the respiratory profile during one-lung ventilation for thoracotomy.
Summary In this randomised controlled trial we examined the effects of four different levels of positive end expiratory pressure (PEEP at 0, 5, 8 or 10 cmH(2)O), added to the dependent lung, on respiratory profile and oxygenation during one lung ventilation. Forty-six patients were recruited to receive one of the randomised PEEP levels during one lung ventilation. ⋯ However, the physiological deadspace to tidal volume ventilation ratio was significantly lower in the 8 cmH(2)O PEEP group compared with the other levels of PEEP (p < 0.0001). We concluded that the use of PEEP (< or =10 cmH(2)O) during one lung ventilation does not clinically improve lung compliance, intra-operative or postoperative oxygenation despite a statistically significant reduction in the physiological deadspace to tidal volume ratio.