British journal of anaesthesia
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We describe the use of awake fibreoptic intubation in the management of a patient with a known difficult airway, who presented with stridor resulting from supraglottic oedema. The aetiological factors contributing to this supraglottic oedema included coexisting thyroid swelling and congestive cardiac failure. Options for appropriate airway management in such cases are discussed.
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Anaesthesia equipment problems may contribute to anaesthetic morbidity and mortality. The magnitude and pattern of these problems are not established. We wanted to analyse the frequency, type and severity of equipment-related problems in our department, and if additional efforts to improve safety were needed. ⋯ The rate of equipment problems was low, and most often of low severity. Aside from improvements in routines for preoperative equipment checks, no specific strategies for problem reduction could be suggested. The incidence of equipment problems is not a good quality indicator because of the low rate of occurrence. However, recorded equipment problems may be useful for improving quality, by analysing causative factors, and suggesting preventative strategies.
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Gut ischaemia may contribute to morbidity in sepsis, but little is known about the metabolic state of the gut mucosa in such patients. ⋯ The results suggest that, either lactic acidosis in rectal mucosa is related to shock severity, or that norepinephrine causes mucosal ischaemia. In any case, metabolic dysfunction is present in the rectal mucosa in patients with abdominal septic shock treated with norepinephrine.
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Recent evidence indicates that sevoflurane treatment before prolonged ischaemia reduces infarct size in normal hearts, mimicking ischaemic preconditioning. We examined whether exposure to sevoflurane before brief ischaemia, inducing a 'stunned myocardium', provided such protective effects in an isolated working heart from normal or septic rats. ⋯ The current study demonstrates that pre-treatment with sevoflurane minimizes myocardial dysfunction and the incidence of reperfusion arrhythmia after brief ischaemic insults in septic hearts.
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Case Reports
Intrathecal morphine overdose during combined spinal-epidural block for Caesarean delivery.
We describe a 25 mg intrathecal morphine overdose during a combined spinal-epidural block for a Caesarean delivery. Naloxone infusion (5.24 mg over 24 h) was started prior to the patient becoming symptomatic and almost immediately after the overdose. Invasive therapeutics such as mechanical ventilation were avoided.