Anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of near-infrared spectroscopy and jugular bulb oximetry in comatose patients resuscitated from a cardiac arrest.
One cause of cerebral damage in comatose patients resuscitated from a cardiac arrest is cerebral ischaemia occurring during the postresuscitation period. Near-infrared spectroscopy has been advocated as a useful monitor of brain oxygenation, but data on clinical use in comatose postarrest patients are not available. Therefore, we compared regional oxygen saturation measured with the INVOS 3100 with global oxygen saturation measured using jugular bulb oximetry in 10 comatose patients successfully resuscitated from an out-of-hospital cardiac arrest. ⋯ This increase was significantly correlated with the rise in cerebral blood flow and cardiac index, indicating that regional oxygen saturation is influenced by both cerebral and extracerebral components. We conclude that regional cerebral oxygen saturation measured with the INVOS 3100 cannot be compared with global cerebral oxygen saturation measured with jugular bulb oximetry in comatose patients resuscitated from a cardiac arrest. This may be due to characteristics of the INVOS 3100 or to the distribution of cerebral blood flow after cardiac arrest.
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Randomized Controlled Trial Clinical Trial
Airway auscultation. A new method of confirming tracheal intubation.
Unrecognised accidental oesophageal intubation remains an important cause of morbidity and mortality in anaesthetic practice. We have evaluated a new method of distinguishing tracheal from oesophageal intubation using a simple adaptation of an ordinary stethoscope which is inserted into the patient end of the breathing system. We call this technique 'airway auscultation'. ⋯ In contrast, when the tube is in the oesophagus either squeaks or a flatus-like noise is heard or else there is no sound. In 100 healthy adults two observers rapidly identified 99 intubations correctly in a randomised single-blind trial. We recommend further widespread evaluation of this device as it appears to be an effective, simple and rapid method of detecting oesophageal intubation and confirming tracheal intubation which may be of particular use in situations where capnography is not available.
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Randomized Controlled Trial Clinical Trial
Interaction of vecuronium and atracurium during halothane anaesthesia in children.
The combination of vecuronium and atracurium was studied in 60 children of ASA physical status 1 or 2. In part I, the dose-response relationships were determined in 30 children who were randomly assigned to receive a single bolus of 0.02, 0.025 or 0.03 mg kg-1 of vecuronium or 0.075, 0.01 or 0.0125 mg.kg-1 of atracurium. The evoked electromyogram of the adductor pollicis brevis muscle to train-of-four stimulation was monitored. ⋯ We conclude that the dose-response relationships of vecuronium and atracurium in children undergoing halothane anaesthesia are not parallel and the neuromuscular effects of vecuronium and atracurium are neither additive nor synergistic. While vecuronium has a shorter duration of action than atracurium, this feature is not apparent when it is combined with atracurium in equipotent doses. Recovery is rapid and not prolonged when these two drugs are combined.
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We report the occurrence of an accidental pleural puncture by an epidural catheter that happened during the attempted induction of thoracic epidural anaesthesia using a paramedian approach in an awake patient. The incorrect placement of the catheter was recognised while the patient was undergoing thoracoscopic surgery. The possibility of accidental pleural puncture during attempted thoracic epidural catheter placement by either the paramedian or the midline approach should be borne in mind. A misplaced catheter may injure lung tissue and result in a potentially dangerous intra-operative tension pneumothorax.
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Failed intubation associated with difficulty with ventilation is rare. Cricothyrotomy may provide a means of oxygenating the patient, but in practice it may be difficult to perform and does not establish a definitive airway. We report two patients in whom percutaneous tracheostomy was used as an emergency procedure. In both cases placement was extremely rapid and salvaged the situation, leaving a definitive airway.