British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Hypnotic and anaesthetic action of thiopentone and midazolam alone and in combination.
This study examined the interaction between i.v. administered midazolam and thiopentone on the loss of response to verbal command ("hypnosis") and the loss of response to transcutaneous electrical stimulation of the ulnar nerve ("anaesthesia") in patients presenting for minor elective surgery. Dose-response curves for thiopentone and midazolam individually and in combination were determined using the two end-points in 300 unpremedicated patients. ⋯ Although midazolam failed to produce anaesthesia in the dose range used, the dose of thiopentone required to produce anaesthesia was reduced by 50% in the presence of midazolam. The mechanism of interaction and the potential role of benzodiazepine-barbiturate combinations are discussed and the observed synergistic anaesthesia interaction is used to explain the potentially dangerous combination of benzodiazepines with other potent CNS depressants such as barbiturates and alcohol.
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Extracorporeal circulation techniques are being used increasingly in patients with acute cardiac or pulmonary failure. Some of these patients may subsequently require transportation, which has limited the use of these techniques in hospitals without on site transplantation facilities. We report a case of adult respiratory distress syndrome that demonstrates a solution to this problem.
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Editorial Comment
Developments in the safe use of high frequency jet ventilation.
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Randomized Controlled Trial Clinical Trial
Prevention of hypotension following spinal anaesthesia for elective caesarean section by wrapping of the legs.
Twenty-four parturients undergoing elective Caesarean section were allocated randomly to have the legs wrapped with elasticated Esmarch bandages immediately following spinal anaesthesia or to serve as controls. Significant hypotension (systolic arterial pressure less than 100 mm Hg and less than 80% of baseline value) was treated with i.v. ephedrine in 5-mg boluses. ⋯ Systolic arterial pressure was significantly (P less than 0.05) less in control subjects at 4, 5 and 6 min following spinal injection. No patient in the leg wrapped group became hypotensive following removal of the elasticated bandages.