Anaesthesia
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Mild induced hypothermia improves neurological outcome and reduces mortality among initially comatose survivors of out-of-hospital cardiac arrest. Similar pathological processes occur in the heart and the brain, namely ischaemia followed by reperfusion injury. ⋯ There are variable reports of harm to the myocardium caused by mild induced hypothermia, including reduced myocardial contractility and cardiac output, electrocardiographic changes and arrhythmias, especially bradycardia. These harmful effects are reversible with rewarming.
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We analysed 366 claims related to regional anaesthesia and analgesia from the 841 anaesthesia-related claims handled by the National Health Service Litigation Authority between 1995 and 2007. The majority of claims (281/366, 77%) were closed at the time of analysis. The total cost of closed claims was pound12,724,017 (34% of the cost of the anaesthesia dataset) with a median (IQR [range]) of pound4772 (pound0-28,907 [pound0-2,070,092]). ⋯ Non-obstetric claims were more likely to relate to severe outcomes than obstetric ones. The maximum values of claims were higher for claims related to neuraxial blocks and eye blocks than for peripheral nerve blocks. Despite many limitations, including lack of clinical detail for each case, the dataset provides a useful overview of the extent, patterns and cost associated with the claims.
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We measured the level of contamination in 207 breathing system filters of five different models. The median (IQR [range]) levels of contamination measured in relative light units on the machine side of the filters were: HMEF 750/S 27 (16-56 [4-13 615]); Ultipor BB25 26 (13-40 [9-66]); Humid-vent filter pedi 19 (15-34 [11-48]); Hygroboy 11 (7-19 [3-113]); and Hygrobaby 9 (6-14 [4-21]). ⋯ Excessive contamination on the machine side of the filter could be from the patient or from the re-used breathing system and could result in cross-infection. The level of contamination may need to be checked routinely during each list.
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We present the use of the SensaScope, an S-shaped rigid fibreoptic scope with a flexible distal end, in a series of 13 patients at high risk of, or known to have, a difficult intubation. Patients received conscious sedation with midazolam or fentanyl combined with a remifentanil infusion and topical lidocaine to the oral mucosa and to the trachea via a trans-cricoid injection. Spontaneous ventilation was maintained until confirmation of tracheal intubation. ⋯ Difficulties included a poor view associated with a bleeding diathesis and saliva, transient loss of spontaneous breathing, and difficulty in advancing the tracheal tube in a patient with unforeseen tracheal narrowing. A poor view in two patients was partially improved by a high continuous flow of oxygen. The SensaScope may be a valuable alternative to other rigid or flexible fibreoptic scopes for awake intubation of spontaneously breathing patients with a predicted difficult airway.
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Comparative Study
Histopathological effects on epidural tissue of bolus or continuous infusions through an epidural catheter in ewes.
This study was performed to evaluate the histopathological effects of epidural drug injection given either by intermittent bolus or continuous infusion through a catheter on epidural tissue. Fourteen ewes received intermittent bolus injections of morphine with bupivacaine, or a bolus of the same drugs followed by continuous infusion for 5 days. After 5 days, histopathological examination of the epidural space revealed mild to moderate inflammatory changes, and focal fibrosis surrounding the catheter in all ewes. The similarity of the inflammatory reaction in the control and drug treated groups seems to indicate that neither intermittent bolus or continuous infusion after a bolus dose caused histopathological changes in the epidural space beyond that caused by the catheter itself.