Anaesthesia
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Randomized Controlled Trial Clinical Trial
Continuous thoracic epidural fentanyl for post-thoracotomy pain relief: with or without bupivacaine?
Twenty-five ASA 1 or 2 patients undergoing thoracotomy were entered into a prospective, randomised, double-blind study comparing thoracic epidural fentanyl alone and thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief, pulmonary function and cardiovascular stability were assessed. ⋯ The incidence of side effects attributable to epidural fentanyl was high, but hypotension did not occur. Small doses of bupivacaine administered together with fentanyl into the thoracic epidural space improve analgesia without causing hypotension.
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We modified a Penlon Nuffield 200 for use in a monoplace hyperbaric oxygen chamber by feeding back the chamber pressure to the reducing valve of the Nuffield 200. This provides a compensating mechanism, allowing the ventilator to deliver adequate tidal volumes at pressures of up to 3 atmospheres. We report the laboratory testing of the ventilator and our experience of ventilating two patients with carbon monoxide poisoning. Although compensation is not complete the modification is adequate for short-term clinical use in patients in whom the airway is compromised but who need hyperbaric oxygen therapy.
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Experience of the use of the Cerebrotrac 2500 EEG monitor in 17 patients subjected to artificial ventilation in an intensive care unit is reported; seven were receiving continuous sedation with morphine, midazolam and propofol singly or in combination and 10 received both sedation and the neuromuscular blocking agent, atracurium. The processed EEG patterns could not be precisely correlated with a standard clinical scoring system but were useful in determining the adequacy of sedation, particularly when a muscle relaxant was used. ⋯ The ability to detect cerebral irritability or isolated epileptiform discharges using this apparatus is, however, questionable. The equipment was easy to use and robust; the running costs were 9.5p per hour.
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Prothrombin time and activated partial thromboplastin time were measured in two groups of 30 patients each. Blood sampled from an arterial line after various discard volumes and from a central venous line were compared with direct venipuncture control samples. ⋯ The only exception was activated partial thromboplastin time in group 2 patients when the discard volume from the arterial line is only 2.5 ml above the deadspace volume of the connecting line. At least 5 ml of discard volume must be withdrawn before sampling, to obtain reliable results.
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Pressure recordings were made during passage of a Tuohy needle from the interspinous ligament to the subarachnoid space for lumbar drain insertion. Epidural space pressures were always positive. ⋯ Use of a closed measurement system such as this facilitates the development of large transdural pressure gradients because of the inability of the epidural space pressure to equilibrate with atmospheric pressure. This may contribute to ease of dural puncture.