British journal of anaesthesia
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We describe a case in which regional anaesthesia for Caesarean section was initially avoided because of the presence of systemic infection. However, attempted induction of general anaesthesia resulted in failed tracheal intubation and so an epidural catheter was sited and used for the operation. Awake fibreoptic tracheal intubation was performed after surgery, when it was clear that ventilatory support on the intensive care unit would be needed. The relative risks of regional versus general anaesthesia when infection and difficult laryngoscopy coincide are discussed.
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Peripheral nerve blocks are almost always performed as blind procedures. The purpose of this study was to test the feasibility of seeing individual nerves of the brachial plexus and directing the block needle to these nerves with real time imaging. ⋯ The use of ultrasound appears to permit accurate deposition of the local anaesthetic perineurally, and has the potential to improve the success and decrease the complications of infraclavicular brachial plexus block.
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The Brandt tracheal tube keeps cuff pressure constant during anaesthesia, but the mechanisms have not been examined. We assessed volume, pressure and gas concentration in the cuff and pilot balloon using the Brandt system. ⋯ The Brandt tracheal tube maintains stable cuff pressure during nitrous oxide anaesthesia because of a highly compliant balloon. The concentration gradient of nitrous oxide between the cuff and pilot balloon also contributes to the stable-cuff pressure because the high nitrous oxide concentration in the cuff reduces nitrous oxide influx.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery.
This study investigated whether haemodilution-enhanced coagulation can be demonstrated under regional anaesthesia, whether this occurs before surgery, and whether the fluid used influences the effect. ⋯ This study confirms that the enhanced perioperative coagulation mechanism is related to dilution, rather than surgery, and is triggered by rapid crystalloid haemodilution. Consideration should be given to the use of colloid rather than crystalloid solutions for rapid fluid loading in vasculopathic patients undergoing surgery.