British journal of anaesthesia
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Nasotracheal intubation is frequently used for airway management during maxillofacial surgery. Complications such as haemorrhage occur more frequently with this route of intubation than with the orotracheal route. This case report describes a male patient aged 51 yr who developed severe epistaxis after the tube had passed the nares. ⋯ Attempts using an intubating laryngeal mask airway and a Bonfils intubating fibrescope did not succeed. The airway was finally managed by cricothyroidotomy. A modified sequence of nasotracheal intubation is proposed to avoid similar life-threatening complications.
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Randomized Controlled Trial Clinical Trial
Magnesium sulphate only slightly reduces the shivering threshold in humans.
Hypothermia may be an effective treatment for stroke or acute myocardial infarction; however, it provokes vigorous shivering, which causes potentially dangerous haemodynamic responses and prevents further hypothermia. Magnesium is an attractive anti-shivering agent because it is used for treatment of postoperative shivering and provides protection against ischaemic injury in animal models. We tested the hypothesis that magnesium reduces the threshold (triggering core temperature) and gain of shivering without substantial sedation or muscle weakness. ⋯ Magnesium significantly reduced the shivering threshold. However, in view of the modest absolute reduction, this finding is considered to be clinically unimportant for induction of therapeutic hypothermia.
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Randomized Controlled Trial Clinical Trial
Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia.
Conflicting effects of neuromuscular blocking drugs and anticholinesterases on depth of anaesthesia have been reported. Therefore we evaluated the effect of atracurium and neostigmine on bispectral index (BIS) and middle-latency auditory evoked potentials (AAI). ⋯ These data suggest that neostigmine alters the state of propofol-remifentanil anaesthesia and may enhance recovery.
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Randomized Controlled Trial Clinical Trial
Effect of three different anaesthetic agents on the postoperative production of cardiac troponin T in paediatric cardiac surgery.
Paediatric cardiac surgery is associated with some degree of myocardial injury. Ischaemic preconditioning (IP) has been investigated widely in the adult population. Volatile agents have been shown to simulate IP providing extra protection to the myocardium during adult cardiopulmonary bypass (CPB) while propofol seems to act through different mechanisms. IP has not been investigated in the paediatric population to the same extent. Cardiac troponin T (cTnT) is a reliable marker of myocardial injury in neonates and children. We have investigated the relationship between three anaesthetic agents, midazolam, propofol, and sevoflurane, and postoperative production of cTnT. ⋯ Midazolam, propofol, and sevoflurane appear to provide equal myocardial protection in paediatric cardiac surgery when using cTnT as a marker of myocardial damage.