Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Clinical Trial Controlled Clinical Trial
Clinical assessment of the muscular response to tetanic nerve stimulation.
The study was undertaken in order to determine clinical tactile evaluation of tetanic nerve stimulation (50 Hz, 5 sec) as a means of detecting fade and possible residual curarization. Forty-four patients were studied and 128 clinical evaluations by eight different observers were performed at various levels of neuromuscular blockade. Tetanic fade was detected reliably by clinical evaluation only when high degrees of fade (tetanic fade ratio of 0.3 or less) were detected with a force-displacement transducer. We conclude that the clinical tactile assessment of the response to tetanic stimulation is not accurate except at very high degrees of fade and that its usefulness in monitoring neuromuscular recovery is doubtful.
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Randomized Controlled Trial Clinical Trial
Analgesia and postoperative hypoxaemia after gastric partition with and without bupivacaine wound infiltration.
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To determine the accuracy of end-tidal PCO2 (PETCO2) measurements analyzed with a sidestream capnometer in infants and children whose lungs were ventilated with a Sechrist infant ventilator and an Ayre's t-piece, we compared PETCO2 measurements obtained from the proximal (PETCO2-p) and distal (PETCO2-d) ends of the tracheal tube to arterial PCO2 (PaCO2) in 37 healthy infants and children between 1.3 and 24.5 kg. Both PETCO2-p and PETCO2-d accurately approximated PaCO2, however, the mean (+/- SD) arterial to end-tidal PCO2 difference (delta(a-ET)PCO2) was significantly greater with proximal (1.27 +/- 1.54 mmHg) than with distal sampling (0.64 +/- 1.64 mmHg) (P less than 0.01). In the subgroup of patients who weighted less than 12 kg, the delta(a-ET)PCO2 using proximal gas sampling (1.94 +/- 1.29 mmHg) was also significantly greater than it was using distal sampling (0.74 +/- 1.31 mmHg) (P less than 0.001). We conclude that although statistically different, both proximal and distal estimates of PETCO2 provide acceptable estimates of PaCO2 in healthy infants and children who are ventilated with a Sechrist infant ventilator and an Ayre's t-piece system.