European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
The orthogonal two-needle technique: a new axillary approach to the brachial plexus.
Ninety-eight patients scheduled for elbow, forearm, wrist or hand surgery were allocated randomly to one of two different techniques of brachial plexus block, both using the axillary approach. The blocks were all performed at the level of the insertion of the lateral margin of the pectoralis major muscle on the humerus. The same mixture and volume of anaesthetic solution (30 mL of a mixture of equal parts of 0.5% bupivacaine with adrenaline 1:200 000 and 2% lignocaine) was injected through two needles positioned above and below the axillary artery, in the fascial compartments containing the median and ulnar nerves, respectively. ⋯ In a second group (n = 58) the needles were inserted orthogonally with respect to the neurovascular bundle pathway, aimed towards the posterior fascial compartment containing the radial nerve. Using the second technique, all the terminal branches of the brachial plexus were more frequently involved in the block, including the distribution of the musculocutaneous nerve. It seems likely that the inclination of the needles causes a preferential spread of the anaesthetic solution which follows the direction of the needle shaft.
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A non-invasive method for measuring pulmonary oxygen exchange is described using a plot of inspired oxygen partial pressure (PIO2) vs. oxygen saturation (SpO2). This method was assessed using nine normal subjects and 35 patients undergoing major surgery, including five thoracotomies. In each patient PIO2 was varied to produce a range of values of SpO2 between 85% and 99%. ⋯ The model allows the inspired to arterial difference in PO2 to be divided into (a) an inspired to 'ideal' alveolar difference attributable to the balance between alveolar ventilation and oxygen uptake; (b) an 'ideal' alveolar to end-capillary difference attributable to inhomogeneity in ventilation/perfusion ratios; and (c) end-capillary to arterial difference attributable to true shunt, which was termed 'virtual shunt' because of the uncertainties of assuming fixed values for haemoglobin concentration and arteriovenous oxygen content difference. The coefficient of determination showed that there was a good fit of the model to the data. Because the method is model-based it enables extrapolation to different PIO2 values as well as the study of the evolution of changes in gas exchange under varying conditions.
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Randomized Controlled Trial Clinical Trial
Effects of prostaglandin E1 on intra-operative central and peripheral temperatures during upper abdominal surgery.
Effects of prostaglandin E1 (PGE1) on temperatures during upper abdominal surgery under isoflurane anaesthesia were studied. Forty-five patients were randomly assigned to one of three groups (15 patients per group). One group received 0.05 micrograms kg-1 min-1 of PGE1, the second group received 0.1 microgram kg-1 min-1 of PGE1 just after the induction of anaesthesia, and the third group received no PGE1 during anaesthesia (control). ⋯ In the 0.1 microgram kg-1 min-1 group, maximum decrease of tympanic membrane temperature was significantly larger than that in the control group. Fingertip temperatures in the 0.05 micrograms kg-1 min-1 group during surgery were significantly higher than those in the control group. This result suggests that 0.05 micrograms kg-1 min-1 of PGE1 may be superior to 0.1 microgram kg-1 min-1 of PGE1 for maintaining central and peripheral temperatures during surgery and general anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effects of propofol on laryngeal reactivity and the haemodynamic response to laryngeal mask insertion.
The ease of the insertion of laryngeal mask and the haemodynamic response were assessed 2 min after induction of anaesthesia with either propofol 2.5 mg kg-1 or thiopentone 4.0 mg kg-1 in 38 ASA I premedicated patients. The inserting conditions scored as excellent, good, poor and unable to insert were significantly better with propofol than with thiopentone (P < 0.001). Insertion of the laryngeal mask was followed by a transient but significant increase in both systolic (P < 0.05) and diastolic (P < 0.01) arterial pressure in the thiopentone group; there was no comparable response in the propofol group. The heart rate varied little from baseline in both groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intravenous and inhalational maintenance anaesthesia for endoscopic procedures in the aspirin intolerance syndrome.
Intravenous (n = 21) and inhalational maintenance anaesthesia (n = 21) were compared by random allocation in patients with the aspirin intolerance syndrome undergoing endoscopic nasal procedures. Premedication was with oral midazolam and intravenous methylprednisolone sodium succinate 10 mg kg-1. Anaesthesia was induced in both groups with etomidate and alfentanil and ventilation was controlled. ⋯ On later challenge testing, 125 mg of intravenous methylprednisolone significantly reduced the peak expiratory flow (P < 0.05) in one of these patients. The results suggest that intravenous and inhalational maintenance anaesthesia are equally suitable for patients with aspirin intolerance syndrome. Corticosteroids during surgery should be given by the same route used pre-operatively (spray, oral, or spray plus oral) because intravenous injection may have adverse effects.