Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1988
Comparative Study Clinical Trial Controlled Clinical TrialCardiovascular effects of sedative infusions of propofol and midazolam after spinal anaesthesia.
The cardiovascular effects of intravenous sedation were studied in fifty patients after spinal anaesthesia for lower limb or pelvic surgery. Twenty patients received propofol (mean dosage 74 (SD 4) micrograms/kg/min for 0-20 minutes and 51 (SD 7) micrograms/kg/min for 20-40 minutes), twenty received midazolam (35 micrograms/kg + 2.54 (SD 0.2) micrograms/kg/min for 0-20 minutes and 1.35 (SD 0.2) micrograms/kg/min for 20-40 minutes) and ten patients received saline infusion only. The forearm vasoconstriction in response to the spinal anaesthesia was measured by strain gauge plethysmography. ⋯ In the control group, however, forearm vasoconstriction increased during 40 minutes in theatre (P less than 0.05). Recovery from propofol was far more rapid than after midazolam and was virtually complete in ten minutes. This was reflected by an increase in blood pressure and in forearm vasoconstriction in the recovery period.
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Anaesth Intensive Care · Aug 1988
Anaesthesia for extracorporeal shockwave lithotripsy at the Victorian Lithotripsy Service--the first 300 patients.
A prospective survey was undertaken of the anaesthesia for the first 300 patients at the Victorian Lithotripsy Service. The majority (71.7%) were not hospitalised on site, including four quadriplegics and two ASA grade IV patients. Two hundred and eighty-three (94.3%) patients received continuous lumbar epidural anaesthesia, sixteen (5.3%) received general anaesthesia and one received a spinal anaesthetic. ⋯ There was a 90% patient follow-up rate and the most common postoperative complication was backache (101 patients, 37.4%). The problems of anaesthesia for extracorporeal shockwave lithotripsy are discussed. Epidural anaesthesia offers a number of advantages for this procedure and proved very suitable for the majority of patients.
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Anaesth Intensive Care · Aug 1988
Epidermolysis bullosa--a review of 15 years' experience, including experience with combined general and regional anaesthetic techniques.
Eight patients with epidermolysis bullosa received a total of 60 anaesthetics for 67 procedures over the fifteen-year period 1972 to 1986. On twenty-three occasions patients were intubated. On thirteen occasions general anaesthesia was supplemented by regional blockade, involving a total of thirty-four local anaesthetic blocks. Complications from intubation were minimal and none were seen related to regional blockade.
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Anaesth Intensive Care · Aug 1988
A method of detecting oesophageal intubation or confirming tracheal intubation.
A method of testing the location of an endotracheal tube, in the trachea or oesophagus, was subjected to trial. The test involves drawing back on the plunger of a 50 ml syringe connected with airtight fittings to the endotracheal tube connector, with the endotracheal tube cuff deflated. ⋯ The method was 100% accurate in fifty intubations, 25 tracheal and 25 oesophageal. The technique has been in routine use by one author for several years without giving an incorrect answer and enthusiastic use by other authors is producing the same result.
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Anaesth Intensive Care · Aug 1988
Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope.
Many anatomical factors in difficult intubation at direct laryngoscopy have been evaluated. Lateral radiographs were taken of nineteen patients in whom tracheal intubation proved particularly difficult, and fourteen patients whose intubation was reasonably straightforward. ⋯ A formula and graph have been derived to relate these variables with likelihood of difficulty, and a method has been described of applying this information at the bedside, without using X-ray examination, to estimate the likelihood of difficulty in intubating a new patient. Eighteen months' experience of the application of this clinical evaluation have so far found it reliable.