British journal of anaesthesia
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In nine patients, with preoperative ICP monitoring, anaesthesia was induced with thiopentone 5 mg kg-1 given over 1 min, followed by pancuronium 0.1 mg kg-1. After manual hyperventilation with nitrous oxide and oxygen for 3 min they were given thiopentone 2.5 mg kg-1 over 30 s (phase 1); 30 s later laryngoscopy was performed and topical analgesia administered to the larynx. Endotracheal intubation was performed 1 min after spraying the cords (phase 2). ⋯ Although there was a significant decrease (P less than 0.05) in MAP at the end of the second dose of thiopentone, there were no other significant changes in ICP, MAP or PaCO2 throughout the study. In two patients there were transient decreases in cerebral perfusion pressure to less than 60 mm Hg. Although MAP increased in five of the patients during laryngoscopy and intubation, there was no increase in ICP, showing that the MAP was still within the autoregulatory limits.
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Case Reports
Spinal anaesthesia for caesarean section. Management of a parturient with severe cardiovascular disease.
A parturient with severe mitral valve disease and pulmonary oedema was admitted to the labour ward. Fetal distress was also present. An emergency Caesarean section was undertaken under spinal blockade. The reasons for the choice of this technique are discussed.
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A thirty-year review of the two major British anaesthetic journals, Anaesthesia and the British Journal of Anaesthesia, was undertaken. Overseas contributors accounted for 30% of the total articles published, with North America providing the greatest proportion. The remainder of the contributions came from the United Kingdom. ⋯ The North West Thames Region with 9%, contributed the single largest percentage of the British articles. There was a marked difference in the Regional contributions, not invariably linked to the size of the Authority or the number of University Departments. Over the thirty-year period there was a progressive increase in the number of published articles and an increase in the proportion of overseas contributors.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of alcuronium with edrophonium or neostigmine.
The reversal of alcuronium by edrophonium 1 mg kg-1 or neostigmine 35.7 micrograms kg-1 was compared in 23 patients undergoing elective ophthalmic surgery. Neuromuscular transmission was assessed by measuring the force of contraction of the adductor pollicis muscle in response to train-of-four supramaximal stimuli (2 Hz, 0.2 ms duration) delivered via surface electrodes to the ulnar nerve every 10 s. Anaesthesia was induced and maintained with Althesin, and patients were ventilated to normocarbia with 67% nitrous oxide in oxygen. ⋯ Recovery of the first contraction response of the train-of-four and of fade were more rapid after edrophonium. Although most patients were monitored for at least 30 min no re-curarization was seen. Comparison of the relative rates of recovery of the first contraction, and the response to train-of-four stimuli, suggests that edrophonium has a greater prejunctional effect than neostigmine.
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The results of early extubation after open heart surgery for congenital heart disease in 209 consecutive patients have been reviewed. No patient younger than 3 months of age, 52% of those between 3 and 12 months, and 88% of those older than 12 months had the tracheal tube removed in the operating theatre. Four patients required reintubation of the trachea, three because of respiratory difficulty and one because of cerebral oedema. ⋯ Twelve patients had PaO2 values less than 8.0 kPa after operation, despite adequate oxygen therapy. In four of these, this was related to persistent intracardiac shunting. It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk in carefully selected patients.