British journal of anaesthesia
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The role of nitrous oxide in modern anaesthesia is questioned. The routine use of nitrous oxide was almost completely stopped in our department after November 1, 2000, and we now report some consequences. ⋯ The staff questionnaire showed a strong acceptance of the new policy, and the use of other anaesthetic agents did not increase as expected. Has the value of nitrous oxide been overestimated?
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This study was designed to determine if a new point-of-care test (PFA-100) platelet function analyser) that assesses platelet function predicts blood loss after cardiac surgery. ⋯ The PFA-100 is a logical test for detecting patients who could have excessive bleeding after CPB. However, the PFA-100 was not able to separate patients at low risk of subsequent bleeding from those who had substantial bleeding.
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The central veins that are usually cannulated are the jugular, subclavian, femoral and brachial. If subclavian catheterization is difficult using surface landmark techniques, we now use ultrasound to catheterize the infraclavicular axillary vein. This approach is not widely used and the ultrasound appearance has not been formally described. We examined the anatomical relationships of the axillary vessels to guide safe cannulation of the axillary vein. ⋯ The axillary vein is an alternative for central venous cannulation and we present an anatomical rationale for its safe use. Less arterio-venous overlap and a greater distance between artery and vein and from vein to rib cage should provide an increased margin of safety for central venous cannulation.
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The distribution and elimination of glucose solutions can be analysed by means of a volume kinetic model, but the ability of the model to predict plasma dilution ('model linearity') has not been evaluated. ⋯ The volume kinetic model for glucose 2.5% is linear and can therefore be used for computer simulation as long as marked glycosuria does not occur.