Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of intraoperative ventilation strategies on perioperative atelectasis.
Several methods of ventilation have previously been shown to reduce intraoperative atelectasis and alveolar to arterial oxygen gradient (A-a DO2) in healthy patients. This study was designed to show firstly the relative intra-operative benefit and secondly if any method had an effect on atelectasis postoperatively. Using a factorial design we randomized 24 patients to each of the four ventilatory interventions (manual inflations, large tidal volumes, PEEP, and pressure control inverse ratio ventilation (IRV)). ⋯ This study demonstrated that PEEP and IRV were most effective in reducing intraoperative A-a DO2 (P < 0.05 ANCOVA). Using more than one intervention did not improve the A-a DO2. No method had any effect on postoperative A-a DO2.
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Anaesth Intensive Care · Jun 1998
Case ReportsRecurrent acute upper airway obstruction after anterior cervical fusion.
A 67-year-old man presented with cervical myelopathy for which a C3/4 discectomy and anterior fusion was performed. Recurrent episodes of acute upper airway obstruction necessitated laryngoscopy and endotracheal intubation. Drainage of a prevertebral collection of CSF and surgical repair of a dural tear corrected the obstructive symptoms. Management of the difficult airway is discussed.
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Anaesth Intensive Care · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of forced air warming on postoperative oxygen consumption and temperature in elective orthopaedic surgery.
Actively warming patients during surgery is considered the best method of preventing inadvertent hypothermia. In order to investigate the effect of forced air warming on postoperative oxygen consumption, we studied 26 patients undergoing orthopaedic surgery using a prospective, randomized trial design. ⋯ This study demonstrated the gradual heat gain and also the potential for hyperthermia from pre- and intraoperative forced air warming. We conclude that forced air warming is not necessary for moderate duration non-body-cavity surgery if effective preinduction covering of patients and minimal surgical exposure is achieved.
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Pethidine is an effective epidural opioid for the treatment of acute pain. Its use has been well described in Australian and New Zealand practice, particularly in the field of obstetric anaesthesia. ⋯ Because of its intermediate lipid solubility, pethidine may have advantages over many other epidural opioids. However, potential for accumulation of norpethidine limits its use to relatively short durations of treatment.