British journal of anaesthesia
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Clinical Trial Controlled Clinical Trial
Laryngoscopy and fibreoptic intubation in acromegalic patients.
Acromegaly is recognized as a cause of difficulty in airway management and tracheal intubation. We evaluated prospectively the conditions for laryngoscopy and fibreoptic intubation in 15 acromegalic patients. Each patient served as his or her own control. ⋯ The larynx could not be seen with both techniques in one patient, and the trachea was intubated blindly with the help of an introducer. Our results showed that fibreoptic intubation may prove difficult or fail in acromegalic patients. Difficulties in seeing the vocal cords with a fibrescope were present most often in patients who also had probable intubation difficulties with a rigid laryngoscope.
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An end-stage renal failure patient, receiving chronic treatment with the anticonvulsants, sodium valproate and primidone, showed accelerated recovery with enhanced elimination (T1/2(z) = 52 min) and clearance (Cl = 14.4 ml min-1 kg-1) of rocuronium. The pharmacokinetic and pharmacodynamic effects of rocuronium in this patient are compared with those published for healthy and renal failure patients. Increased hepatic binding of rocuronium rather than metabolism is suggested as the possible cause of this effect.
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Injection of formalin into the hind paw of the rat evokes a biphasic nociceptive behavioural response, which is considered to be an animal model of postoperative pain in humans. The initial response (phase 1) is caused by activation of peripheral nociceptors and is followed by a second phase attributed to ongoing activity in primary afferents and increased sensitivity of dorsal horn neurones. The latter effect is thought to result from glutamate-mediated N-methyl-D-aspartate receptor activation. ⋯ Therefore we contend that supramaximal doses of intrathecal remifentanil sufficient to inhibit phase 1 activity still permitted sufficient glutamate release to allow spinal facilitation. Incomplete suppression of spinal excitatory neurotransmitter release by intrathecal opioids is consistent with spinal wind-up that is triggered during phase 1 and results in phase 2 afferent drive. This might reflect one of the mechanisms underlying post-operative pain.
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Randomized Controlled Trial Clinical Trial
Benefits of intraoperative skin surface warming in cardiac surgical patients.
We have investigated patients undergoing cardiac surgery with hypothermic bypass to see if the addition of skin surface warming during systemic rewarming on bypass (heated group, n = 43) would improve perioperative thermal balance compared with conventional management without skin warming (control group, n = 43) in an open, randomized, controlled study. Intraoperative skin warming with a water mattress and forced warm air over the face, neck and shoulders attenuated the afterdrop in nasopharyngeal temperature after weaning from bypass (2.3 (1.2) degrees C and 1.3 (0.5) degrees C in the control and heated groups, respectively) (P < 0.05) and resulted in higher rectal temperature 4 h after surgery. ⋯ There was a significant inverse correlation between rectal temperature on arrival in the ICU and postoperative blood loss (r = 0.57, P < 0.001). These data suggest that additional skin surface warming with a water mattress and forced warm air helped to preserve perioperative thermal balance and may contribute to reduced bleeding after cardiac surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Positive pressure ventilation with the laryngeal mask airway in non-paralysed patients: comparison of sevoflurane and propofol maintenance techniques.
We have compared anaesthetic maintenance and emergence characteristics of propofol and sevoflurane with the laryngeal mask airway (LMA) at commonly used doses in 185 ASA I-II patients, in a randomized, prospective study. Anaesthesia was induced with propofol 2.5-3.5 mg kg-1 and fentanyl 1-3 micrograms kg-1. Neuromuscular blocking agents were not used. ⋯ Postoperative problems did not differ between groups. We conclude that propofol 6-8 mg kg-1 h-1 and 1.5% sevoflurane were suitable for maintenance of anaesthesia for musculoskeletal surgery in non-paralysed ASA I-II patients undergoing PPV with the LMA. Emergence was more rapid with sevoflurane, but was associated with more excitatory phenomena.