Anaesthesia and intensive care
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Anaesth Intensive Care · May 1985
Evaluation of the technique of central venous catheterisation via the external jugular vein using the J-wire.
This paper reports the results of a prospective study to evaluate the success rate and incidence of complications with the external jugular approach to central venous cannulation using a J-tipped spring guide wire. In a personal series of 100 consecutive patients in whom the technique was attempted, successful placement was achieved in 90, but more importantly there were no immediate technical complications. During the study, internal jugular cannulation was used in fourteen patients because either an external jugular vein was not visible (four patients), could not be cannulated (three patients), or the guide wire could not be manipulated into an intrathoracic position (seven patients). The technique is recommended as the initial method where central venous cannulation must be performed under suboptimal conditions and in very sick patients in whom a serious complication may prove to be fatal.
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Mannitol is an osmotic diuretic commonly used to reduce intracranial pressure. While various side-effects, including hyperosmolar states, precipitate reduction in intracranial pressure, rebound phenomenon and hypervolaemia have been described, hypotension due to rapid administration has not been widely recognised.
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Anaesth Intensive Care · May 1985
Comparative Study Clinical Trial Controlled Clinical TrialA comparative study of techniques of postoperative analgesia following caesarean section and lower abdominal surgery.
A double-blind, within-patient trial was carried out to compare intramuscular pethidine 100 mg, epidural pethidine 50 mg and epidural bupivacaine 25 mg for pain relief on the day after caesarean section or lower abdominal gynaecological surgery. Analgesia was assessed on a visual analogue pain scale. Forced expiratory volume in one second (FEV 1.0) and venous plasma catecholamine levels were measured immediately before and approximately thirty minutes after each treatment. ⋯ A mean increase in FEV 1.0 of 18% occurred after both of the epidural treatments, but this did not achieve statistical significance. There was no significant change in catecholamine levels after any of the treatments. Epidural pethidine was preferred by patients over and above intramuscular pethidine and epidural bupivacaine (p less than 0.05).
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Anaesth Intensive Care · May 1985
Review Comparative StudyRecently developed alternatives to conventional mechanical ventilation.