British journal of anaesthesia
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High-frequency oscillation (HFO) is a widely used lung-protective ventilatory strategy in paediatric and neonatal acute lung injury. Its safe and effective use has been hindered by inadequate recruitment of the lung during oscillation and, until recently, the lack of an adequately powered oscillator for use in adult practice. ⋯ We found HFO, in conjunction with manual recruitment and prone positioning, to be a well-tolerated mode of ventilation in adolescents with ARDS and who were unresponsive to conventional ventilation. Given this success we hope to renew interest in this method for adults with ARDS, together with concurrent use of manual recruitment.
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Case Reports
Peripartum management of a patient with Glanzmann's thrombasthenia using Thrombelastograph.
We describe the perioperative management of a 31-yr-old primipara with Glanzmann's thrombasthenia, who required urgent Caesarean delivery at 33 weeks' gestation. Peripartum haemorrhage was inevitable and was pre-empted by transfusion of multiple blood products, the effects of which were monitored by Thrombelastograph. The blood products given are discussed.
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The pharmacokinetics of the alpha-2 adrenoceptor agonist dexmedetomidine were studied in 10 patients requiring postoperative sedation and mechanical ventilation in the intensive care unit (ICU), and compared with previous volunteer data. ⋯ Mean dexmedetomidine pharmacokinetic variables seen in postoperative, intensive care patients were similar to those previously found in volunteers, with the exception of the steady-state volume of distribution. A small loading dose provided effective sedation with no adverse events.
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The infraclavicular vertical brachial plexus block, first described by Kilka and coworkers, offers a more proximal spread of anaesthesia for the upper extremity than the classic axillary approach. In this technique, the puncture site is defined as lying at the exact centre of an infraclavicular line (k) between the jugular fossa and the ventral process of the acromion. Our study was designed to determine whether the point so defined (P) corresponds with the optimal puncture site determined sonographically (S) and to develop an improved prediction model. ⋯ The suggested modification should help to increase the success rate of the infraclavicular vertical brachial plexus block while decreasing the rate of potentially severe complications, although individual ultrasonographic guidance is to be recommended whenever possible.
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The use of the equimolecular mixture of oxygen and nitrous oxide is widely recommended for relief of pain in children undergoing minor procedures. Although the benefits and adverse effects of the clinical use of nitrous oxide seem well known, its effects on the autonomic nervous system have never been studied in children. The aim of this study was to evaluate changes in autonomic cardiovascular activity induced by brief exposure to 50% nitrous oxide in children. This study was based on non-invasive continuous recordings of RR-interval and non-invasive arterial pressure. Vascular and cardiac sympathetic activity and cardiac parasympathetic activity were investigated using spectral analysis of systolic arterial pressure variability (SAPV) and RR-interval variability (RRIV). In addition, the sensitivity of the spontaneous baroreflex (SBR) was assessed using the sequences and the cross-spectral analysis methods. ⋯ Unlike the results demonstrated in adults, our findings show very few cardiovascular effects of nitrous oxide in children. Furthermore, whereas in adults nitrous oxide is associated with an excitatory cardiovascular profile, in children this agent seems to be associated with a depressant cardiovascular profile. The rapid return to baseline after discontinuation of administration and the absence of baroreflex changes are positive attributes for the use of nitrous oxide in children.