British journal of anaesthesia
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We have examined, under reproducible conditions, the resistance to airflow of complete anaesthetic breathing systems (Magill, Coaxial Lack, Parallel Lack and Bain systems) and components of these systems. All systems had resistances within the recommended ranges at all flows likely to be experienced in normal clinical practice. The Magill system had the lowest resistance under all conditions. It is concluded that comparisons should be made only between complete breathing systems.
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Randomized Controlled Trial Clinical Trial
Doxacurium chloride: a preliminary clinical trial.
The onset, duration of action and reversibility of doxacurium were studied in 27 anaesthetized patients, using doses of 37.5 micrograms kg-1 (1.5 x ED95) and 62.5 micrograms kg-1 (2.5 x ED95). Onset was slow and, whilst tracheal intubation was always possible 3 or 4 min after injection, the conditions were not ideal. With the higher dose a mean 97.6 (SD 5.2)% block of the response of adductor pollicis to ulnar nerve stimulation was obtained in 9.85 (6.17) min and recovery of the integrated EMG response to 20% of control took 102 min (42 min). ⋯ Antagonism of block with edrophonium 1 mg kg-1, whilst fast in onset, was rarely complete; with neostigmine 50 micrograms kg-1 antagonism was satisfactory. No adverse haemodynamic effect was seen, although a gradual onset of bradycardia, which responded to atropine or glycopyrrolate, was noted in 12 of the patients. No histamine release or other adverse effects were noted.
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Case Reports
Anaesthetic management for caesarean section in a patient with uncorrected truncus arteriosus.
We describe the successful management of a 25-yr-old primigravida with uncorrected truncus arteriosus, requiring an urgent Caesarean section for delivery of a live infant and we discuss the rationale of using the chosen drug combination and the importance of adequate monitoring in selecting an anaesthetic technique based on the pathophysiology of the congenital cardiac lesion.
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Randomized Controlled Trial Clinical Trial
Alfentanil obtunds the cardiovascular and sympathoadrenal responses to suxamethonium-facilitated laryngoscopy and intubation.
Alfentanil 75 micrograms kg-1 or saline (control group) was given 1 min before induction of anaesthesia in 20 healthy patients premedicated with diazepam 0.14 mg kg-1 and pethidine 1 mg kg-1. Anaesthesia was induced with a sleep dose of thiopentone preceded by glycopyrrolate. Suxamethonium 1 mg kg-1 was used to facilitate laryngoscopy (which lasted 10 s) and tracheal intubation. ⋯ All these changes were attenuated in patients pretreated with alfentanil (n = 10), but four patients had chest wall rigidity. Changes in the QT interval correlated directly with the changes in plasma noradrenaline concentration (r = 0.67). Plasma adrenaline concentrations decreased during induction of anaesthesia in both groups.