British journal of anaesthesia
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Until recently epidural abscess was considered a rare, almost theoretical, complication of central nerve block, but anecdotal reports suggest that this is no longer the case. Thus a review of the risk factors, pathogenesis, clinical features and outcome of this condition is appropriate, the primary aim being to make recommendations on best anaesthetic practice to minimize the risk of this serious complication. A search of EMBASE(c), PUBMED(c) and MEDLINE(c) databases from 1966 to September 2004 was performed using several strategies, supplemented by reference list screening. ⋯ Epidural abscess can be a catastrophic consequence of central nerve block. Early diagnosis will minimize permanent damage, but primary prevention should be the aim. There is a need for a large survey to indicate the true incidence to better inform the risk-benefit ratio for central nerve block.
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A computer controlled infusion device for S(+) ketamine was used in combination with a Diprifusor device to provide anaesthesia for 20 ASA I or II patients undergoing elective colonoscopy. The aim of the study was to assess the performance of the pharmacokinetic model for S(+) ketamine used in the delivery algorithm of the device. ⋯ It was necessary to modify the original published pharmacokinetic parameters incorporated into the S(+) ketamine delivery system in order to simulate improved PK performance during short procedures (<1 h duration) where propofol was concurrently administered. This improved performance was confirmed in a further prospective study.
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Direct indicators for the evaluation of the nociceptive-anti-nociceptive balance during general anaesthesia do not exist. The aim of this study was to combine physiological parameters to obtain such an indicator. ⋯ The empirically developed algorithm of RN leads to an index that seems to adequately estimate the nociceptive-anti-nociceptive balance at skin incision during general anaesthesia. In the future, CSSA may serve as a reference for studies investigating methods aimed at evaluating this pharmacodynamic component of anaesthesia.
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The predominant effect of opioids on respiratory pattern during anaesthesia is an increase in the duration of expiration (an effect on 'timing'), but there may also be changes in tidal volume (an effect on 'drive'). Timing and drive are controlled by separate neuronal systems, but are infrequently considered individually. The effects of opioids on breathing are not well characterized clinically because changes in carbon dioxide and anaesthetic levels usually occur at the same time, and can obscure the effects of the opioid. ⋯ Small doses of opioid given when anaesthesia and carbon dioxide are stable affect respiratory timing predominantly, but in addition changes in the pattern of motor output can be detected.
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The LMA CTrach is a new laryngeal mask system consisting of an LMA CTrach Airway with integrated fibreoptic channels, and a detachable LMA CTrach Viewer. This system enables viewing of the larynx and aids endotracheal intubation through a laryngeal mask airway. Method. We used and evaluated this system in 100 adult patients undergoing general anaesthesia for elective surgery. Our primary outcomes were the success rates of LMA CTrach Airway insertion and endotracheal intubation with this system. ⋯ The LMA CTrach system has potential advantages over the LMA Fastrach system, including the ability to align the LMA outlet with the larynx and a high first intubation attempt success rate. However, it was difficult to view the larynx with the LMA CTrach compared with direct laryngoscopy, and expectations must be moderated.