Anaesthesia
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This study of the obstetric and anaesthetic circumstances relating to 100 consecutive Caesarean sections under general anaesthesia suggests that the general anaesthesia rate for Caesarean section could be reduced from the present 37 to 27% by making maximum use of epidural block and to 16% by using subarachnoid block in addition. The need for general anaesthesia on account of urgency to deliver can be greatly reduced by the administration of epidural analgesia during labour in patients identified as being more likely than average to require Caesarean section, and by the use of subarachnoid block when the need for section arises unexpectantly. Patients' objections to undergoing Caesarean section while conscious were analysed, and suggestions are made for minimising the number of patients who decline. Technical problems with blocks may sometimes be overcome without resort to general anaesthesia, while patients at risk from haemorrhage or coagulopathy will continue to require general anaesthesia.
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Case Reports Comparative Study
High frequency venturi jet ventilation. Adult respiratory distress syndrome--a case report.
A Penlon Nuffield Series 200 Ventilator, adapted for use as a high frequency jet ventilator, was used to treat a patient with adult respiratory distress syndrome. Adequate alveolar ventilation with this method was achieved with lower mean intrapulmonary pressure (5.4 cmH2O) than with conventional intermittent positive pressure ventilation (IPPV) (6 cmH2O). An improved cardiac output was also apparent, as judged by a better systemic blood pressure [105/50 mmHg for high frequency jet ventilation (HFJV) compared to 90/40 mmHg for IPPV] and a lower central venous pressure 6 cmH2O for HFJV as compared to 9.5 cmH2O with conventional IPPV. ⋯ This allowed an assessment to be made of any potential neurological damage caused by the cervical fracture. An assessment had not been possible during conventional ventilation due to the heavy narcotic and sedative regime required to settle the patient. This case report provides further evidence that HFJV is a useful adjunct in the management of patients requiring mechanical ventilation and also that the Penlon Nuffield Series 200 Ventilator is capable of high frequency jet ventilation.
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The effect upon the neonate of a short period of maternal hypotension sustained during the initiation of spinal analgesia for Caesarean section was studied. Babies born to mothers with hypotension were significantly more acidotic than controls although acid-base levels were still within normal limits. Neurobehavioural studies were found to be normal in both groups at 4 and 24 hours. It was concluded that a short period (less than 2 minutes) of hypotension was not harmful to the neonate.