Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1999
Case ReportsCaesarean section in a patient with paramyotonia congenita.
This case report details spinal anaesthesia for an elective caesarean section in a patient with the rare condition of paramyotonia congenita. There are few case reports of anaesthesia in this condition and none in the Australian anaesthetic literature. This case highlights the need for the avoidance of hypothermia and depolarizing muscle relaxants, the safety of spinal anaesthesia and a conservative approach to the management of plasma potassium concentration. The subsequent review outlines the current literature and discusses other issues involved in the anaesthetic management of this disorder.
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There have been several reports of propofol becoming extrinsically contaminated with bacteria. These reports have usually related to infusions or delays in administration after the ampoule has been opened. This observational study was performed to examine bacterial contamination of propofol during usual practice in the operating theatres of a single large hospital group. ⋯ This common clinical practice, especially in paediatric anaesthesia, does not comply with the manufacturer's recommendations. The clinical significance of the bacterial contamination detected is not clear. It is recommended that propofol should be handled in an aseptic fashion and measures taken to minimize the risk of bacterial contamination.
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Anaesth Intensive Care · Oct 1999
Supplementary oxygen and the laryngeal mask airway--evaluation of a heat-and-moisture exchanger.
Heat-and-moisture exchangers (HMEs) are routinely used in anaesthesia for the humidification and warming of inspired gases. The use of the Laryngeal Mask Airway (LMA) is widespread, and many anaesthetists choose to leave it in situ until the patient regains consciousness. ⋯ At an oxygen flow rate of 4 l.min-1, the HME provided a mean end-tidal oxygen concentration of 36.2% (+/- 6.2), which compares favourably to other previously described devices. The HME thus represents a convenient, effective and economical means of oxygen supplementation via the LMA.
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Anaesth Intensive Care · Oct 1999
Estimation of alveolar deadspace fraction using arterial and end-tidal CO2: a factor analysis using a physiological simulation.
The alveolar deadspace as a fraction of alveolar ventilation (VDalv/VTalv), while technically difficult to measure, is an objective monitor of pulmonary disease progression and a predictor of successful weaning from mechanical ventilation. The aim of the study was to examine the relationship between the arterial to end-tidal PCO2 gradient (Pa-E'CO2) and VDalv/VTalv and between (Pa-E'CO2)/PaCO2 and VDalv/VTalv using the Nottingham Physiology Simulator, an original, validated physiology simulation. ⋯ The relationship between (Pa-E'CO2)/PaCO2 and VDalv/VTalv (best fit: VDalv VTalv = 1.135 x (Pa-E'CO2)/PaCO2-0.005) during normal physiological conditions was approximately linear and less influenced by physiological variation. Shunt and anatomical deadspace caused some inaccuracy, although they are unlikely to prevent the clinical usefulness of this formula.