British journal of anaesthesia
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Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. Because the pericardium cannot be seen on chest x-ray (CXR), an alternative radiographic marker is needed for correct placement of CVCs. The anatomy of the region was studied in 34 cadavers. ⋯ The carina is a reliable, simple anatomical landmark for the correct placement of CVCs. In almost all cases, the carina is radiologically visible even in poor quality, portable CXRs. CVC tips should be located in the SVC above the level of the carina in order to avoid cardiac tamponade.
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Dry lime causes a loss of volatile anaesthetics by degrading and adsorbing them. Degradation produces toxic substances and heat. Rehydration of lime stops degradation. ⋯ Humidity increased steeper with fresh lime, whereas absorbent weight increased more with dried lime; halothane increased both variables (F + H: 99%, 8 g; F - H: 93%, 6 g; D + H: 58%, 17 g; D - H: 24%, 15 g). Surprisingly, temperature remained constant, probably because of the high gas flow (70 litres min-1) generated inside the Physioflex. These findings indicate rehydration of dried lime by humid gases and a rapid cessation of the loss of halothane in the PhysioFlex.
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Randomized Controlled Trial Clinical Trial
Korean hand acupressure reduces postoperative vomiting in children after strabismus surgery.
A double-blind, randomized, placebo-controlled study was conducted to investigate the effectiveness of Korean hand acupuncture in preventing postoperative vomiting in children scheduled for strabismus surgery. In one group, acupressure was performed 30 min before induction of anaesthesia by applying an acupressure disc onto the Korean hand acupuncture point K-K9; the disc remained in situ for at least 24 h. ⋯ In the acupressure group, the incidence of vomiting was significantly lower (20%) than in the placebo group (68%). We conclude that Korean hand acupressure of the acupuncture point K-K9 is an effective method for reducing postoperative vomiting in children after strabismus repair.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cricoid pressure applied after placement of laryngeal mask impedes subsequent fibreoptic tracheal intubation through mask.
We studied 70 patients to see if cricoid pressure applied after insertion of the laryngeal mask altered the success rate of tracheal intubation through the mask. After induction of anaesthesia and neuromuscular blockade, patients were randomly allocated to have either cricoid pressure (Group C) or sham pressure (Group S). The view of the glottis through the laryngeal mask was assessed before and after the test pressure, and tracheal intubation through the mask was attempted using a fibreoptic bronchoscope. ⋯ The success rate of tracheal intubation in group S (31 patients) was significantly higher than in group C (21 patients, P << 0.001; 95% CI for difference: 9-48%). The time for insertion of the fibrescope in group S (median (95% CI): 12 (11-12) s) was significantly faster than in group C (16 (14-17) s, P << 0.001; 95% CI for difference: 3-6 s), and the time for tracheal intubation in group S (16 (15-18) s) was significantly faster than in group C (22 (19-24) s, P < 0.0005; 95% CI for difference: 3-7 s). Cricoid pressure after insertion of the laryngeal mask makes tracheal intubation through the mask significantly more difficult.