British journal of anaesthesia
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Clinical Trial
Patient-controlled sedation using propofol in elderly patients in day-case cataract surgery.
Patient-controlled sedation (PCS) with propofol has been used successfully as an adjunct to local anaesthetic procedures. We studied a group of elderly patients (mean age 75.4 yr) undergoing cataract surgery and attempted to increase patient acceptability and comfort of local anaesthesia. Propofol was self-administered in a dose of 0.25 mg kg-1 for patients more than 60 yr of age, with a lockout period of 3 min. ⋯ However, while it is possible to administer PCS successfully to elderly patients undergoing cataract surgery and produce a decrease in the level of anxiety, we found it unacceptable because of head movement in two patients. These patients received only two and three divided doses, to a maximum of 29 and 30 mg, respectively. There were no other adverse events.
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A major cause of impaired gas exchange during general anaesthesia is atelectasis, causing pulmonary shunt. A 'vital capacity' (VC) manoeuvre (i.e. inflation of the lungs up to 40 cm H2O, maintained for 15 s) may re-expand atelectasis and improve oxygenation. However, such a manoeuvre may cause adverse cardiovascular effects. ⋯ At an inspired oxygen concentration of 40%, PaO2 increased from 17.2 (4.0) kPa before to 22.2 (6.0) kPa (P = 0.013) after the VC manoeuvre. Thus in anaesthetized adults undergoing mechanical ventilation with healthy lungs, inflation of the lungs to a Paw of 40 cm H2O, maintained for 7-8 s only, may re-expand all previously collapsed lung tissue, as detected by lung computed tomography, and improve oxygenation. We conclude that the previously proposed time for a VC manoeuvre may be halved in such subjects.
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Comment Letter Meta Analysis
Ropivacaine and bupivacaine for analgesia in labour.
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Clinical Trial
Sevoflurane anaesthesia with an Oxford Miniature Vaporizer in vaporizer inside circle mode.
Anaesthesia was induced and maintained successfully with sevoflurane using an Oxford Miniature Vaporizer (OMV) in vaporizer inside circle (VIC) mode. With continuous monitoring using the Drager Narkomed 4 machine agent analyser, the expired sevoflurane concentration was monitored and controlled easily. During induction, there was no cardiovascular depression, apnoea or coughing, but involuntary movements and breath-holding were common.
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Editorial Comment
Rapacuronium (Org 9487): do we have a replacement for succinylcholine?