Anaesthesia
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One hundred and fifteen patients scheduled for elective Caesarean section under regional anaesthesia were questioned to determine their personality profiles and anxiety state. Positive correlations were found between neuroticism and anxiety scores (p < 0.05). ⋯ In general, previous experience did not reduce pre-operative anxiety and personality appeared to be a better predictor of anxiety prior to Caesarean section under regional anaesthesia. Some personality types might benefit from additional support to improve their ability to cope with this stressful event.
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A case is described of a 56-year-old man who developed bilateral diaphragmatic paralysis following surgery remote from the course of the phrenic nerves. This rare complication is reviewed and the management of subsequent anaesthesia described.
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The Bicore CP-100 pulmonary monitor offers the advantage of continuous pulmonary monitoring at the bedside. Using an easily placed oesophageal balloon catheter and a flow transducer within the ventilator system, intrathoracic pressures, airway pressures and airway flow can be measured, and from these the Bicore calculates 25 other respiratory variables. The monitor screen displays real time waveforms of airway pressure, airway flow, oesophageal pressure and inspired tidal volume, and with these data it should be possible to determine more accurately when patients can be weaned from mechanical ventilation. ⋯ To assess the ease of use and potential benefit, the Bicore was used to calculate the work of breathing while weaning eight patients from mechanical ventilation in a spontaneous breathing mode. The pressure support ranged from 20 cmH2O, 10 cmH2O and 5 cmH2O, to a continuous positive airway pressure of 5 cmH2O, all with a positive end-expiratory pressure of 5 cmH2O, down to a single T-circuit with no positive airway pressure or end-expiratory pressure. The work of breathing while on a Veola Hamilton ventilator was found to be about the same, while receiving pressure support of 20 cmH2O compared to a continuous positive airway pressure of 5; the other forms of respiratory support increased the work of breathing significantly.
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Combined continuous spinal-epidural anaesthesia with a single interspace, double-catheter technique.
A double catheter, single interspace combined spinal-epidural anaesthetic was performed in 12 ASA grade 3 patients. The technique failed in one patient in whom the intrathecal catheter could not be inserted satisfactorily. ⋯ As opposed to a classical combined spinal-epidural block, this technique is most suitable for very debilitated patients. The advantages are the ability to titrate the intrathecal dose of the local anaesthetic to achieve the desired dermatomal level and to test the correct position of the epidural catheter before injecting drugs intrathecally.