Anaesthesia
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Two cases are presented which illustrate the essential features, diagnosis and management of malignant hyperthermia. Both cases occurred in association with isoflurane, and in patients who were exposed during previous anaesthetics to recognised trigger agents without apparent manifestation of the syndrome.
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Life-threatening extensions of conduction block during obstetric epidural analgesia can be classified according to the risk to the mother. High blocks that occur in the presence of the anaesthetist should present a readily treatable problem. Reports of total spinal anaesthesia that occur with no anaesthetist in attendance call for a reappraisal of present practice. Changes in current anaesthetic practice, which might increase safety with epidural analgesia, are top-ups by midwives, but only when the anaesthetist is on the delivery suite; repeated assessment of the nature of the conduction block by an anaesthetist; and continuous infusions with anaesthetist-only top-ups.
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Subdural placement of the tip of the Tuohy needle or epidural catheter may account for many unexpected complications of attempted epidural blockade, for example, 'unexplained' headache, false-negative aspiration test down needle or catheter, false-negative test dose, unilateral block, delayed total spinal and neurological sequelae, as well as profound block of delayed onset that is characteristic of subdural blockade. Cases are reported in support of this hypothesis.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
The Bain, ADE, and Enclosed Magill breathing systems. A comparative study during controlled ventilation.
The Enclosed Magill, Humphrey ADE and the Bain breathing systems are all used for controlled ventilation of the lungs. This study compares the three systems in vitro with a lung model and in clinical practice. No difference was observed, with ventilatory variables commonly used in clinical practice, between the Bain and the ADE, while significantly lower end-tidal carbon dioxide values were observed with the Enclosed Magill (about 7%). Lower fresh gas flows can be used under these circumstances to maintain normocapnia with the Enclosed Magill than either the Bain or the Humphrey ADE.