British journal of anaesthesia
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Multicenter Study Clinical Trial
The intubating laryngeal mask. II: A preliminary clinical report of a new means of intubating the trachea.
We have assessed the efficacy of a new laryngeal mask prototype, the intubating laryngeal mask airway (ILMA), as a ventilatory device and blind intubation guide. The ILMA consists of an anatomically curved, short, wide bore, stainless steel tube sheathed in silicone which is bonded to a laryngeal mask and a guiding handle. It has a single moveable aperture bar, a guiding ramp and can accommodate an 8 mm tracheal tube (TT). ⋯ In 10 of 13 (77%) of these patients, no resistance was encountered and the trachea was intubated at the first attempt; three of 13 (23%) patients required one adjusting manoeuvre. Tracheal intubation required significantly fewer adjusting manoeuvres in patients with a predicted or known difficult airway (P < 0.05). We conclude that the ILMA appeared on initial assessment to be an effective ventilatory device and intubation guide for routine and difficult airway patients not at risk of gastric aspiration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of methohexitone and propofol with or without alfentanil on seizure duration and recovery in electroconvulsive therapy.
We have studied the effects of methohexitone and propofol with and without alfentanil on seizure duration and recovery in this observer-blinded, prospective, randomized, crossover study involving 24 patients undergoing electroconvulsive therapy (ECT). Each patient had four treatment sessions, and received the following four i.v. regimens in random order: methohexitone 0.75 mg kg-1, methohexitone 0.50 mg kg-1 and alfentanil 10 micrograms kg-1, propofol 0.75 mg kg-1, propofol 0.50 mg kg-1 and alfentanil 10 micrograms kg-1. Additional methohexitone or propofol was given as needed in 10-20-mg increments until loss of consciousness. ⋯ Recovery time was statistically shorter in patients receiving propofol compared with methohexitone-alfentanil and methohexitone alone. Alfentanil with a reduced dose of methohexitone or propofol provided unconsciousness and increased seizure duration in patients undergoing ECT. We conclude that the combination of methohexitone with alfentanil is a good regimen for ECT, especially for patients with short seizure duration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Heat retention using passive systems during anaesthesia: comparison of two plastic wraps, one with reflective properties.
Hypothermia during prolonged surgery may be prevented by active and passive warming methods. We have compared randomly two types of occlusive body wraps in groups of 20 patients. One wrap had additional reflective properties which, by reducing radiative in addition to convective and evaporative heat loss, was expected to improve heat conservation. ⋯ Skin and core body temperatures increased and core temperature exceeded 37 degrees C in 40% of patients in both groups. This continuous increase in temperature was unexpected and the observed heat gain may have been stimulated endogenously by the type of surgery rather than that supplied externally. Overall, mean hourly heat gain was similar in both groups: 71 (SD 28) kJ h-1 in the reflective group and 67 (33) kJ h-1 in the other group.
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Randomized Controlled Trial Clinical Trial
Partly exhausted soda lime or soda lime with water added, inhibits the increase in compound A concentration in the circle system during low-flow sevoflurane anaesthesia.
We performed low-flow sevoflurane anaesthesia at a flow rate of 1 litre min-1 in three groups (n = 8 each) using 600 g of fresh soda lime (control group), 600 g of soda lime with 60 ml of water added (water group) or 600 g of soda lime saturated with carbon dioxide, that is partly exhausted soda lime (carbon dioxide group). Degradation products in the system were measured hourly. ⋯ The mean maximum concentration of compound A was significantly higher in the control group (mean 16.0 (SD 5.0) ppm) than in the water (1.4 (1.0) ppm) or carbon dioxide (4.0 (1.8) ppm) group, and the maximum temperature of the soda lime was significantly lower in the carbon dioxide group (30.7 (3.5) degrees C) than in the control (43.4 (1.8) degrees C) or water (40.8 (1.8) degrees C) group (P < 0.05). The use of partly exhausted soda lime or soda lime with water added reduced compound A concentrations in the system during low-flow sevoflurane anaesthesia.