Annales françaises d'anesthèsie et de rèanimation
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The laryngeal mask ensures a better control of the airway than the face mask, without the disadvantages of an endotracheal tube. Moreover, it provides an effective and simple solution to many problems of difficult intubation and therefore it has a place amongst the equipment required for difficult intubations. The laryngeal mask will most probably become more widely used, provided that its contra-indications are taken into account. ⋯ Many studies have shown that propofol is suitable for use with the laryngeal mask. However, it should be noted, that there is, as yet, no conclusive evidence of the superiority of propofol over other induction agents. In anaesthesia for day-case surgery, the combination of the laryngeal mask and propofol could prove beneficial.
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The Univent tube was designed as an alternative to double lumen endotracheal tubes. It is a conventional single lumen tube with an additional small channel within the concave anterior wall portion that houses a movable bronchial blocker used for lung isolation. A thin lumen in the blocker itself allows lung deflation and various ventilatory patterns (oxygen inflow, CPAP, jet-ventilation) in the blocked lung. ⋯ The "blind" insertion of the bronchial balloon carries a high risk of primary malpositioning or secondary displacement that may cause a loss of the lung isolation or even tracheal obstruction. Initial insertion with fiberoptic bronchoscope is therefore required and this device must also be available during the whole period of one lung ventilation. High pressures generated by the bronchial cuff and higher cost than that of double lumen endotracheal tubes are two other factors that limit the use of the Univent tube.
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Ann Fr Anesth Reanim · Jan 1994
[The injured brain. Basis for hydroelectrolytic and hemodynamic resuscitation].
Brain insult in neurosurgical patients is highly dependent on hydroelectrolytic and haemodynamic disturbances. The magnitude of their effect is related to blood-brain barrier integrity and characteristics of cerebral perfusion pressure. Moderate disturbances in ionic balance or CPP may lead to interstitial oedema or worsening of cerebral ischaemia. ⋯ Normovolaemia and the choice of an appropriate agent for plasma volume expansion are essential. Correction of hypovolaemia is best obtained with (except for packed red cells when necessary) normal saline, 4% human albumin or hydroxyethylstarch. The benefit of utilizing hypertonic electolytic or HES solutions in neurosurgical patients has still to be assessed.
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Ann Fr Anesth Reanim · Jan 1994
[Training in anesthesiology and surgical intensive care in the United Kingdom].
A review of the training in anaesthetics in the United Kingdom is presented. After basic medical training and obtaining the MB BS qualification, the trainee will usually spend a year outside anaesthetics. Following this period, basic specialist training takes approximately four years, going through senior house officer and registrar grades, leading to the Fellow of the Royal College of Anaesthetist (FRCA) diploma. ⋯ A Certificate of Accreditation is awarded after three years of satisfactory experience in a senior registrar post. The accredited senior registrar is then ready to apply for a consultant vacancy or a senior lecturer's post. Academic appointments are made at registrar and senior registrar levels (lecturers) and consultant level (as senior lecturers and professors).
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We report the bench testing of three new anaesthesia ventilators: Flexima (Datex), SA2/RA2 and Cato (Dräger). The test circuit included a two compartment lung model, a pneumotachograph and a pressure gauge. ⋯ Moreover, the tidal volume of the Flexima increased with the fresh gas flow. In spontaneous ventilation inspiratory resistance were low.