British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
IV anaesthesia with propofol using a target-controlled infusion system: comparison with inhalation anaesthesia for general surgical procedures in children.
We studied 40 children undergoing general surgical procedures. They were allocated randomly to receive induction of anaesthesia with propofol 3-5 mg kg-1 followed by maintenance with halothane and an appropriate regional block, or induction and maintenance of anaesthesia with a computerized, target-controlled infusion of propofol with a regional block. ⋯ There were no significant differences between the groups in heart rate, mean arterial pressure and end-expired carbon dioxide concentration during anaesthesia. There was no significant difference in the recovery times of the two groups.
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Flow-volume and pressure-volume loops were measured with continuous spirometry in 49 patients in whom the trachea was intubated "blindly" with a double-lumen endobronchial tube for thoracic surgery. Nineteen endobronchial tubes were malpositioned by fibreoptic bronchoscopic criteria; 63% of these were suspected because of the configuration of the spirometric loops. ⋯ The secondary displacements were identified by abnormal loop configurations and confirmed with fibreoptic bronchoscopy. Continuous spirometric monitoring is helpful in detecting endobronchial tube displacement during intubation and surgery.
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We describe a case of severe acute lung injury after attempted strangulation. The patient presented initially with cerebral irritability and florid, noncardiogenic pulmonary oedema which were followed by a prolonged period of the adult respiratory distress syndrome, severe sepsis and multiple system organ failure, although the patient eventually survived. The pulmonary injury following strangulation is proposed to be a result of the generation of marked subatmospheric pressures within the lungs during vigorous inspiration against an obstructed airway, although the processes involved in the so-called neurogenic pulmonary oedema are difficult to exclude.