British journal of anaesthesia
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The use of inhaled nitric oxide in the critically ill has increased significantly over the past few years but little published information exists on standards for current practice. Sixty-four intensive therapy units in the UK were surveyed by questionnaire from which 54 (84.4%) satisfactory replies were received. We present the survey results and put forward recommendations based on current literature and our own clinical experience for the safe use of inhaled nitric oxide.
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The processed electroencephalogram (pEEG) was monitored in eight patients undergoing gynaecological laparotomy under combined extradural and nitrous oxide-isoflurane anaesthesia. Pre-incisional mean spectral edge frequency 95 percentile (SEF95) and median frequency (MF) were 11.67 (SD 1.63) Hz and 3.74 (0.24) Hz, respectively. ⋯ After introduction of extradural analgesia, these variables returned to pre-incisional values (SEF95 11.65 (1.73); MF 4.02 (0.41)). Reduction of end-tidal isoflurane from 1.0% to 0.5% after extradural analgesia did not cause significant pEEG changes. pEEG may assist anaesthetists to recognize adequacy of combined general-extradural anaesthesia.
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We describe the use of the continuous wave oesophageal Doppler monitor (ODM II) in the perioperative management of a patient with chronic obstructive coronary artery disease undergoing transmyocardial revascularization (TMR). The use of ODM II allowed both quantitative and qualitative assessment of cardiac function relatively noninvasively. It detected the successful transmyocardial penetration of a laser beam during operation by visual and auditory phenomena in addition to reflecting improvement in cardiac performance after operation.
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Eight patients were studied under general anaesthesia for elective pulmonary lobectomy to see if intrinsic positive end-expired pressure (PEEPi) would appear or increase in the dependent lung during one-lung ventilation (OLV) or if application of external PEEP equal to individually measured PEEPi would produce better arterial oxygenation, haemodynamic state and oxygen delivery than either zero PEEP (ZEEP) or an external PEEP 5 cm H2O greater than PEEPi. Patients were non-obese, without obstructive airways disease, aged 53-76 yr and ASA < III. ⋯ There was no PEEPi during TLV, but 2-6 mm Hg of PEEPi appeared during OLV. Applying external PEEP equal to individually measured PEEPi reduced venous admixture and increased PaO2 without a decrease in cardiac index (thus increasing oxygen delivery) compared with ZEEP, but the improvement in pulmonary gas exchange was lost and an additional penalty of reduced cardiac output was imposed when external PEEP was increased to 5 mm Hg above PEEPi.