European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients.
To test the hypothesis that magnesium sulphate reduces the amount of remifentanil needed for general anaesthesia in combination with propofol and mivacurium, we studied 50 patients undergoing elective pars plana vitrectomy in a double-blind, randomized prospective fashion. ⋯ We can recommend the use of magnesium sulphate as a safe and cost-effective supplement to a general anaesthetic regimen with propofol, remifentanil and mivacurium, although we cannot clearly distinguish between a mechanism as a (co)analgesic agent at the NMDA-receptor site or its properties as a sympatholytic. The effect of a single bolus dose of 50 mg kg(-1) on induction lasts for about 2 h. For longer cases, either a continuous infusion or repeated bolus doses might be necessary.
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Comparative Study
Colour Doppler imaging of the interspinous and epidural space.
In recent studies, ultrasonic diagnostic imaging has proved useful in the screening of the trajectory of the epidural needle. With regard to possible side-effects of spinal and epidural anaesthesia caused by vessel injury, we aimed to evaluate the usability of Colour Doppler imaging for the depiction of interspinous vessels in prepuncture examination. ⋯ Prepuncture Doppler imaging can provide the epiduralist with information regarding the position of vessels in the needle trajectory. This might help to reduce complications in regional anaesthesia.
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Unilateral malignant hyperinflation of the lungs during positive pressure mechanical ventilation was described during aggressive respiratory therapy of unilateral lung disease or in situations of significant difference in compliance between the two lungs. We report a case of malignant hyperinflation of the nondependent lung during chest surgery. The differential diagnosis and treatment with differential lung ventilation are described.
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Clinical Trial
Quality of anaesthesia for insertion of tension-free vaginal tape using local analgesia and sedation.
The use of tension-free tape in the vagina is a relatively new surgical procedure for the treatment of urinary incontinence. Traditionally, the procedure is carried out using local anaesthesia and sedation. We aimed to assess the quality of anaesthesia obtained during insertion of tension-free vaginal tape using local anaesthetic infiltration and intravenous conscious sedation. ⋯ Satisfactory anaesthetic conditions can be achieved for the insertion of tension-free vaginal tape using local anaesthesia with sedation.
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We present the anaesthetic management of a patient for stenting of a thoracic aortic aneurysm at the site of an aortic coarctation. The specific challenges to the anaesthetist for this case are outlined. These include the specific problems of placing the graft, the obvious risk of aortic rupture and the unfamiliar environment of the separate radiological theatre. The advantages and disadvantages to the anaesthetist of the treatment of thoracic aortic aneurysms with stents are briefly discussed.