Anaesthesia and intensive care
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A mathematical model correlating the spread of analgesia to the dose of local anaesthetic and to age or body weight was found analysing the data of 763 caudal blocks in children from age one day to twelve years. Two graphs have been plotted: (1) spread of analgesia, dose, age and (2) spread of analgesia, dose, weight. Both age and weight can be used as predictors to determine the desired level of analgesia, but weight is more useful in very young patients while age is a better guide in older children.
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Thirteen commercially available ventilator monitoring alarms supplied by the distributors were evaluated. It was decided that devices with no power failure precautions or unprotected variable controls could not be recommended for general use. By these criteria only two devices could be recommended for general use as ventilator alarms and a further three as disconnect alarms; in each instance these recommendations are subject to certain reservations and suggested modifications. A ventilator alarm should be regularly serviced and checked before use and should be not used by anyone unfamiliar with the applications or limitations of that particular device.
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A new approach to the lateral cutaneous nerve of thigh is described. It depends on locating the depth of the canal through which the nerve passes immediately medial to the anterior superior iliac spine. ⋯ Two district 'pops' or loss of resistance can be identified during insertion of a short-bevelled needle. Location of the canal by the technique described has been confirmed radiographically.
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Anaesth Intensive Care · Feb 1986
ReviewExtracorporeal CO2 Removal in severe adult respiratory distress syndrome.
Sixty-five per cent survival has been achieved in a group of patients with severe ARDS and a predicted mortality of 92%, by the use of Gattinoni's technique of extracorporeal CO2 removal. In patients and animals the technique has usually resulted in rapid improvement in the radiographic appearance and lung function. There are several possible mechanisms by which the technique may facilitate lung repair, including improvement of lung tissue oxygenation, the avoidance of high airway pressures and regional alkalosis in the lung, a reduction in oxygen toxicity, and the frequency observed reduction in pulmonary artery pressure. The apparent effectiveness of the technique and other associated evidence have implications which should lead us to reconsider some aspects of our conventional management of patients with severe ARDS.