British journal of anaesthesia
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In clinical practice it is difficult to estimate rapidly two important values: (i) the total age-corrected MAC multiple from measured end-expired concentrations of volatile agent and nitrous oxide; (ii) the end-expired concentration of volatile agent needed to obtain a given total MAC multiple. We have developed a nomogram to do this. ⋯ The nomogram gives accurate results if it covers a whole A4 sheet in landscape format and could be extended to apply to other agents, for example xenon.
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Review Case Reports
Successful weaning from mechanical ventilation after coronary angioplasty.
Weaning failure can be caused by myocardial ischaemia during the switch from mechanical to spontaneous ventilation. We report ischaemic left ventricular failure and ischaemic mitral insufficiency during weaning. ⋯ Transluminal angioplasty made weaning possible. We conclude that acute ischaemic mitral insufficiency may contribute to cardiac failure during weaning and that angioplasty, by reversing it, can allow successful weaning.
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Central venous lines are often used when there is difficulty obtaining peripheral venous access. The basilic and cephalic veins in the mid-arm region, although difficult to see or palpate, can be imaged longitudinally and cannulated using real-time ultrasonography, providing an easy alternative. These techniques are described, with reports of four typical cases.