British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
EEG controlled rapid opioid withdrawal under general anaesthesia.
We performed rapid opioid detoxification under propofol anaesthesia in 30 opioid addicts, using the opioid receptor antagonist naltrexone. Two strategies to obtain a sufficient depth of anaesthesia and to avoid anaesthetic overdose were evaluated. Patients were allocated randomly to one of two groups. ⋯ There were significant differences in the total dose of propofol given (group 1, mean 72 (SD 9) mg kg-1; group 2, 63 (8) mg kg-1; P < 0.01), duration of anaesthesia (318 (53) min vs 309 (42) min; P < 0.05), duration of recovery time (49 (13) min vs 40 (12) min; P < 0.01) and frequency of withdrawal symptoms between groups. In addition, the incidence of side effects was different between groups (62 vs 29 points on a withdrawal symptom scale; P < 0.01). To obtain a sufficient depth of anaesthesia but to avoid inappropriately large doses of anaesthetic, we consider that EEG monitoring is valuable during rapid opioid detoxification.
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The anaesthetic risks of acromegaly include difficulties in airway management, hypertension, and cardiac, gastrointestinal and renal problems. To estimate the incidence of major complications in this rare group of patients, we reviewed 28 patients with acromegaly who had pituitary tumour excision over a 10-yr period. Each patient was matched for age, weight and sex to a non-acromegalic patient undergoing transsphenoidal pituitary surgery. ⋯ Arterial pH was significantly lower (P = 0.015), blood glucose was higher (P < 0.001) and fluid intake minus output was higher (P = 0.04) in acromegalic patients than in controls. Airway difficulty and tongue enlargement were encountered more often in acromegalic patients (P = 0.002 and P = 0.001, respectively). Our data confirm that in acromegalic patients: airway difficulties occurred more frequently; severe haemodynamic instability did not typically occur during surgery for acromegaly; pulmonary gas exchange was not altered during operation; glucose intolerance may be an intraoperative problem; and fluid regulation may be altered.
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Self-citation of a journal may affect its impact factor. We investigated self-citations in the 1995 and 1996 issues of six anaesthesia journals by calculating the self-citing and self-cited rates for each journal. Self-citing rate relates a journal's self-citations to its total number of references. ⋯ This also occurred, to a lesser extent, in the European anaesthesia journals. A significant correlation between self-citing rates and impact factors was found (r = 0.899, P = 0.015). A high self-citing rate of a journal may positively affect its impact factor.
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Tracheal intubation must be performed with great care in the multiply injured patient when it must be assumed that the cervical spine may be damaged. Use of conventional direct laryngoscopy usually requires removal of the neck collar and manual in-line stabilization of the head and neck. The intubating laryngeal mask (ILMA) has been designed to facilitate tracheal intubation in the neutral position. ⋯ In only two patients was intubation successful. These problems were probably caused by the neck collar strap under the chin lifting up and tipping the larynx anteriorly. On the basis of these findings, ILMA use in a subject wearing a neck collar cannot be recommended.