British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly.
In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). ⋯ A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.
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Randomized Controlled Trial Clinical Trial
Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium.
Atracurium-induced intense neuromuscular blockade was evaluated in 60 randomly selected patients using the post-tetanic count (PTC) and train-of-four (TOF) methods. Thirty patients were anaesthetized with thiopentone, nitrous oxide and halothane, and 30 patients received thiopentone, nitrous oxide and fentanyl. In all patients, the response to post-tetanic single twitch stimulation appeared before the response to TOF stimulation, and a close correlation was found between the number of post-tetanic twitches (PTC) and the time interval between the PTC and the first detectable TOF response. ⋯ A PTC of 1 meant that the TOF response would appear in, on average, 9 min (95% confidence limits: 4-14 min). Halothane significantly prolonged the time from injection of atracurium to the first response to post-tetanic single twitch stimulation. It is concluded that the relationship between PTC and the time to first response to TOF nerve stimulation makes the PTC method a valuable supplement to TOF nerve stimulation for neuromuscular monitoring during clinical anaesthesia involving atracurium.
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Malignant hyperpyrexia developed, and was successfully treated, in a 50-year old man undergoing pyelolithotomy. Early diagnosis with the assistance of end-tidal carbon dioxide monitoring facilitated prompt treatment with i.v. dantrolene. A positive muscle biopsy subsequently confirmed the diagnosis. The only likely triggering agent used was isoflurane.
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Biography Historical Article
A British footnote to the life of Horace Wells.