British journal of anaesthesia
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The effect of nitrous oxide on myogenic motor evoked potentials (MEPs) after multipulse stimulation is controversial. We investigated the effects of propofol in this paradigm. MEPs were elicited electrically by a single pulse and by trains of three and five pulses in rabbits anaesthetized with ketamine and fentanyl. ⋯ Administration of low-dose propofol enhanced nitrous oxide-induced suppression, and this effect was reversed by five-pulse stimulation. However, high-dose propofol produced a greater increase in suppression, such that even five-pulse stimulation did not overcome the suppression. The results suggest that the degree of reversal of nitrous oxide-induced MEP suppression produced by multipulse stimulation is affected by the administration of propofol.
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This study details all incidents involving medical devices used in anaesthesia and intensive care reported to the relevant authorities in France in 1998. There were 1004 reports during that year. Incidents were classified as serious (harmful to patients) in 11% of cases; death resulted in 2% of cases. ⋯ User errors, quality control problems during production of the device and design faults were the three main causes. The problems identified during the study period enabled the faulty medical devices to be improved in 12-44% of cases. We conclude that post-marketing vigilance is a useful way of improving the quality of medical devices.
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In an in vitro study, less compound A was formed when a KOH-free carbon dioxide absorbent was used. To confirm this observation we used a lung model in which carbon dioxide was fed in at 160 ml min(-1) and sampling gas was taken out for analysis at 200 ml min(-1); ventilation aimed for a PE'CO2 of 5.4 kPa. The soda lime canister temperatures in the inflow and outflow ports (Tin and Tout) were recorded. ⋯ Median (range) compound Ainsp increased to a maximum of 22.7 (7.9) ppm for Sodasorb and 33.1 (20) for Sofnolime at 60 min and decreased thereafter; the difference between groups was significant (P<0.05) at each time of analysis up to 240 min. The canister temperatures were similar in both groups and increased to approximately 40 degrees C at 240 min. Contrary to expectation, compound A concentrations were greater with the KOH-free absorbent despite similar canister temperatures with both absorbents.