British journal of anaesthesia
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Comparative Study
Comparison of portable emergency ventilators using a lung model.
A lung model was used to test the performance of five emergency ventilators (MEDUMAT Elektronik, MEDUMAT Variabel, OSIRIS, OXYLOG and rescuPAC 2DM). The model comprised two glass jars filled with water to suitable compliances and connecting tubes. ⋯ Preset minute volume was compared with measured minute volume and the gas distribution produced by the different ventilators. Acceptable performance was found with the MEDUMAT Elektronik, MEDUMAT Variabel, OSIRIS and OXYLOG ventilators.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical and radiological comparison of perivascular and transarterial techniques of axillary brachial plexus block.
The perivascular technique of axillary brachial plexus block results in incomplete block of radial and musculocutaneous nerves in 10-20% of patients. With the transarterial technique and a large dose of mepivacaine, success rates of 99% have been reported. We have compared the clinical efficacy of these techniques in 50 patients using 1% mepivacaine 45 ml with adrenaline. ⋯ There were no statistically significant differences in sensory or motor block between the groups at 20 min or in the plasma concentrations of mepivacaine measured 0-45 min after injection. In the CT scans, both proximal and distal spread of the contrast medium were more common after perivascular than after transarterial block. The distribution of the contrast medium was not related to the efficacy of the block.
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Three cases of extradural abscess with delayed presentation after extradural analgesia have been reported previously. The present report describes a patient with alcohol abuse who was treated for 5 days with extradural injections of bupivacaine for pain from multiple rib fractures. The first symptoms of an extradural abscess developed approximately 11 days after removal of the extradural catheter, and definite diagnosis was delayed a further 7 days.
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We have studied the effects of extrinsically applied PEEP (PEEPe) and intrinsic PEEP (PEEPi) on lung volume and peak airway pressure (Paw,peak) in 10 patients with airflow limitation during mechanical ventilation. PEEPe was applied in 2-4 cm H2O increments until values greater than PEEPi were reached. Total lung hyperinflation was quantified by measuring the expired volume resulting from deflation (starting at end inspiration) until cessation of expiratory flow. ⋯ PEEPe at pressures less than PEEPi increased delta FRC by (mean) 186 (SEM) 34 ml/kPa PEEPe (P < 0.05) and increased Paw,peak by 0.6 (0.12) kPa/kPa PEEPe (P < 0.05). In contrast, PEEPe at pressures greater than PEEPi, increased delta FRC by 695 (128) ml/kPa PEEPe (P < 0.05) and Paw,peak by 1.8 (0.26) kPa/kPa PEEPe. We conclude that PEEPe may be applied cautiously at values less than PEEPi when clinically indicated, but the application of PEEPe at values greater than PEEPi may substantially aggravate lung hyperinflation.
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Randomized Controlled Trial Clinical Trial
Improvement in i.v. regional anaesthesia by re-exsanguination before surgery.
A modification of an i.v. regional anaesthesia (IVRA) technique is described in which the arm is re-exsanguinated before surgery (re-IVRA). IVRA and re-IVRA were compared for quality of operative field, sensory and motor block, quality of analgesia and blood concentrations of prilocaine, lignocaine and mepivacaine in a double-blind study in 120 patients undergoing hand surgery. ⋯ Re-exsanguination improved tolerance of the tourniquet. Plasma concentrations in the re-IVRA group showed some increases, but these were not in the toxic range.