British journal of anaesthesia
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A case of prolonged neuromuscular block following the administration of suxamethonium is reported. Three hours after administration of suxamethonium, a well defined, recovering phase II block was demonstrated with a T4:T1 ratio of 0.25, and neostigmine was administered. Although the T4:T1 ratio was improved to 0.9, T1 remained at 25% of control, and significant paralysis persisted which responded to administration of cholinesterase. It is concluded that neuromuscular monitoring cannot reliably predict reversibility in such cases and that, even after 3 h, antagonism of prolonged suxamethonium block should commence with cholinesterase, followed by neostigmine if necessary.
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We have investigated the value of lower oesophageal contractility (LOC) in detecting awareness during anaesthesia in 20 human volunteer patients. LOC was measured either with subjects awake or after induction with propofol, during induction with propofol, and then as consciousness returned. Statistically significant changes were observed in the frequency of spontaneous contractions, peak and mean amplitude of spontaneous and provoked contractions, and the oesophageal contractility index as subjects lost consciousness and also as it was regained. The differences in LOC which occurred when subjects were conscious and unconscious support the view that LOC is related to the depth of anaesthesia, but its unreliability at the interface between consciousness and unconsciousness prevents selective detection of awareness, although the response in the presence of painful stimuli has not been tested.
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Systemic mastocytosis is an uncommon disorder of mast cell proliferation in connective tissues. Mast cell degranulation may occur on exposure to various stimuli and drugs. ⋯ Intradermal skin testing is useful in predicting the sensitivity to drugs that may be used during anaesthesia. We present a patient with systemic mastocytosis who underwent uneventful cholecystectomy.
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We have studied, in the monkey, the critical volume for the production of severe pneumonitis following pulmonary aspiration of gastric contents. Aspiration of 0.4 ml kg-1 and 0.6 ml kg-1 at pH1 produced mild to moderate clinical and radiological changes, but no deaths. ⋯ At 1.0 ml kg-1, 50% of the animals died--a mortality rate considerably less than that reported previously in animal studies. If these results were to be extrapolated to humans, the critical volume for severe aspiration could be increased from 25 ml to 50 ml (0.8 ml kg-1), considerably reducing the percentage of patients perceived to be "at risk".
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of two ventilators used with the T-piece in paediatric anaesthesia.
The Nuffield 200 ventilator was compared with a new valveless ventilator (CW 200) in 20 children undergoing general anaesthesia for paediatric surgery. The new ventilator incorporates design features which overcome the main disadvantages of the Nuffield 200 and make it an inherently safer machine. At identical ventilator settings it produced a significantly greater tidal volume with a reduction in end-tidal carbon dioxide partial pressure. This may have advantages in avoiding pulmonary barotrauma in children.