British journal of anaesthesia
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Five lambs were anaesthetized, paralysed, mechanically ventilated and connected to a membrane "lung" to permit removal of carbon dioxide. When part of the carbon dioxide was removed in this manner, the tidal volume was decreased to keep PaCO2 constant. ⋯ The removal of carbon dioxide by a membrane during positive pressure breathing could decrease barotrauma, particularly in poorly compliant lungs. Technically, the extracorporeal removal of carbon dioxide is relatively simple procedure.
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Ten patients presenting for carniotomy were studied. Each was anaesthetized with thiopentone or Althesin followed by tubocurarine and the lungs were hyperventilated with nitrous oxide in oxygen. Fentanyl 0.2 mg was administered i.v. and the intracranial pressure (i.c.p.) and mean arterial pressure were recorded continuously for 10 min. ⋯ The changes in i.c.p. were small. Cerebral perfusion pressures less than 50 mm Hg were observed in two patients who had moderate hypotension before the drug was given. We conclude that fentanyl is a valuable agent in the hyperventilation technique in patients with intracranial space-occupying lesions, provided that hypotension is absent.
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Biography Historical Article
A history of nitrous oxide and oxygen anaesthesia IVE: Henry Hill Hickman in his time.
More evidence is presented: a questionable letter from a grateful patient; Hickman's stewardship at a Charity Ball; the baptism of his children at Shifnal. The identities of "John" and "Glover", mentioned in Hickman's letter from Paris, and the marriage of one of Hickman's cousins to the son of a French emigré, are discussed. A recorded gift places Eliza in Paris with Henry on November 10, 1828. The need to assess the evidence in the context of its time and place is stressed.
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Critical narrowing of the dependent airways was examined in anaesthetized dogs with closed chests. Two techniques were used, (a) "closing" volume (CV), measured from the expired nitrogen plateau and (b) tantalum bronchography, to measure the calibre of airways of 3-8 mm diameter in the upper (UZ), middle (MZ) and lower (LZ) zones. ⋯ Following stimulation of the vagi CV increased and there was increased narrowing of airways, particularly in LZ. The addition of 0.5% halothane to the anaesthetic abolished the effect of vagal stimulation on CV and on airway resistance.