British journal of anaesthesia
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The aim of this study was to detail the time-course, defined as the changes in end-tidal drug concentration with time, and consumption of inhaled anaesthetics when using a multifunctional closed-circuit anaesthesia machine in various drug delivery modes, and to compare it with a classical anaesthesia machine using an out-of-circle vaporizer under high and low fresh gas flow conditions. ⋯ A combination of the fastest time course and lowest consumption of sevoflurane and desflurane was found when using the Zeus apparatus in AC uptake mode.
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A case is described of extensive subcutaneous emphysema with rapid and life-threatening airway obstruction. The incident followed inadvertent removal of a chest drain in a patient with a persistent air leak from an iatrogenic pneumothorax. The pneumothorax had developed during pacemaker insertion.
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Using commercial computer graphics software (TrueSpace), we constructed a virtual-reality model for teaching interscalene brachial plexus block. This tool combines the clarity of schematic drawings and the clinical relevance of video clips and live demonstrations. The aim is to accelerate learning and aid retention of relevant information. ⋯ Three-dimensional animation is a promising new tool to accelerate the learning of regional anaesthetic techniques.
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Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower thoracic spine and retraction of the left lower lobe of the lung. ⋯ Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167% with diamorphine 0.1 mg ml(-1) provided excellent analgesia. The technique was associated with no postoperative complications.
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The volatile anaesthetics isoflurane and sevoflurane induce both negative and positive inotropic effects in ventricular myocytes, the mechanisms of which are not fully understood. Previous data suggest that changes in myofilament Ca(2+) sensitivity contribute to their sustained negative inotropic effects. In this study, the role of changes in myofilament Ca(2+) sensitivity in both positive and negative inotropic effects of these agents was examined in intact ventricular myocytes. ⋯ These data show that both isoflurane and sevoflurane reduce apparent myofilament Ca(2+) sensitivity at steady state. However, sevoflurane (but not isoflurane) induced transient changes in apparent myofilament Ca(2+) sensitivity, which would contribute to its inotropic profile.