European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia.
Quantitative assessment of myocardial ischaemia during incremental spinal, single-dose spinal and general anaesthesia may provide guidelines for the choice of anaesthetic technique for osteosynthesis of hip fractures in the elderly atherosclerotic individual. Forty-three patients with coronary artery disease were allocated to receive either incremental spinal anaesthesia (bupivacaine 0.5% plain) (A), single-dose spinal anaesthesia (2.5 mL of bupivacaine 0.5% plain) (B) or general anaesthesia (fentanyl, thiopentone, atracurium, enflurane, N2O/O2) (C) for hip surgery. ST segment monitoring was performed from the induction of anaesthesia and for the following 48 h, and perioperative hypotension, blood loss and fluid therapy were recorded. ⋯ In (A), 1.6 mL of 0.5% bupivacaine were used as opposed to the fixed 2.5 mL dose in (B) (P < 0.001). In the first post-operative week, mortality was higher in (B) (P < 0.05) but, after 1 month, there was no significant difference in mortality between the three groups. The incidence of hypotension and myocardial ischaemia was lowest in the group receiving incremental spinal anaesthesia.
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Clinical Trial Controlled Clinical Trial
Accelographic and mechanical post-tetanic count and train-of-four ratio assessed at the great toe.
We examined post-tetanic count (PTC) and train-of-four (TOF) ratios at the great toe assessed accelographically or mechanically and compared these with post-tetanic count and train-of-four ratios evaluated mechanically at the thumb in 24 patients who were given vecuronium. An acceleration transducer was attached to the right great toe, a force transducer to the left great toe and another force transducer to the thumb of the left hand. In the PTC group (n = 12) and TOF group (n = 12), post-tetanic count and train-of-four ratios were simultaneously recorded using the two great toes and the thumb of the left hand respectively. ⋯ In conclusion, the mechanical post-tetanic count at the great toe is lower than the mechanical post-tetanic count at the thumb. In contrast, mechanical train-of-four ratios at the great toe are greater than the mechanical train-of-four at the thumb. Nevertheless, as the mechanical train-of-four ratios at the great toe became comparable with the mechanical train-of-four ratios at the thumb, mechanical assessment of the train-of-four ratio at the great toe may be useful for the evaluation of residual neuromuscular block.
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We aimed to determine whether our results were any better or worse than other published reports and to examine the efficacy of the West Midlands Ambulance Service (WMAS) policy of applying cardiopulmonary resuscitation (CPR) and manual ventilation to all unwitnessed cardiac arrests in preference to immediate defibrillation. All cardiac arrests were studied from October 1994 to September 1996. In all unwitnessed arrests, crews undertook CPR and manually ventilated the lungs via a mask or an endotracheal tube with a bag and valve or a mechanical resuscitator using an FIO2 of 1 or 0.21 for at least 2 min before defibrillation was attempted. ⋯ The European Resuscitation Council Guidelines recommending immediate defibrillation for unwitnessed arrests are not supported by these results. The apparent lack of cerebral damage and the percentage success suggests that resuscitation considerations should be as brain orientated as they are heart orientated. The elapsed time periods reported challenge several shibboleths.
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Letter Case Reports
Forestier disease and interscalene brachial plexus block.