British journal of anaesthesia
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Comparable minimum alveolar concentration (MAC) fractions of volatile anaesthetics produce similar thermoregulatory impairment. Nitrous oxide, however, decreases the vasoconstriction threshold less than sevoflurane or isoflurane. We tested the hypothesis that nitrous oxide also decreases shivering threshold less than isoflurane alone or in combination. ⋯ This study indicates that nitrous oxide reduces the shivering threshold less than isoflurane.
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The relationship between changes in intracranial pressure and incidence of subclinical seizures in patients requiring neurological intensive care is not fully understood. The aim of this study was to investigate if acute increases in intracranial pressure were accompanied by subclinical seizures. ⋯ We conclude from this pilot study that seizures are an uncommon cause of acute raised intracranial pressure. To determine whether raised intracranial pressure causes seizures, long-term monitoring in a large cohort of intensive care patients would be necessary, studying patients with similar diagnoses and ages.
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Caudal analgesia is widely used in paediatric anaesthetic practice. In adults, the 'whoosh' test has been recommended as a guide to successful needle insertion, but it has not been extensively studied in paediatric patients. We have investigated a modification of the 'whoosh' test, which we have christened the 'swoosh' test. It avoids the injection of air by performing auscultation during injection of the local anaesthetic solution. We have compared it with clinical judgement of correct placement. ⋯ The 'swoosh' test is a simple and accurate test to confirm successful caudal insertion in children, and is especially useful as a teaching aid for anaesthetists new to the technique.
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Many preoperative factors can influence perioperative mortality in cardiac surgery. Because the perioperative use of beta-blocking agents may reduce perioperative cardiac complications in non-cardiac surgery, we considered the possibility that beta-blocking agents could improve survival in coronary surgery patients. ⋯ Increasing age and urgency of surgery are associated with greater mortality, whereas preoperative beta-blocking therapy is associated with less mortality. The characteristics of patients who received chronic beta-blockade did not differ significantly from those of patients who did not. The results suggest that chronic preoperative beta-blocker therapy reduces 30-day mortality in coronary surgery.
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Arterial oxygenation can change during one-lung ventilation for reasons that are not fully understood. ⋯ Oxygenation can improve during one-lung ventilation in some patients. This improvement is partly related to a marked increase in Pa(O(2)) during compression of the non-dependent lung.