Anaesthesia
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Randomized Controlled Trial Clinical Trial
2% propofol for sedation in the intensive care unit. A feasibility study.
A 2% solution of propofol has been compared with the 1% formulation for sedation in patients whose lungs were being mechanically ventilated in an intensive care unit following coronary artery bypass surgery. There were no significant differences in the amount of propofol used in the two groups, the rate of propofol infusion or the number of changes made to the infusion rate to maintain the desired level of sedation. ⋯ The mean heart rates of those receiving 2% propofol were significantly higher throughout the period of the study for no apparent reason. Propofol 2% was found to be safe, easy to administer and a practical alternative to the 1% solution for sedating cardiac surgical patients.
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Pulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo-embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be the first time this has been reported.
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Upper oesophageal sphincter pressure has been measured in 24 patients with a sleeve device. The median sphincter pressure when awake was 38 mmHg, and when anaesthetized and paralysed was 6 mmHg. ⋯ With the application of cricoid pressure, operating department assistants raised sphincter pressure to above 38 mmHg in only 50% of patients. Laryngoscopy made little difference to the effect of cricoid pressure except in one patient in whom it reduced the sphincter pressure by 27 mmHg.
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A new approach for the management of frozen shoulder associated with reflex sympathetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified by its response to nerve stimulation. ⋯ The choice of blockade of the suprascapular nerve is a new concept for the management of the frozen shoulder of reflex sympathetic dystrophy. This is based on the fact that the nerve contains a high proportion of sympathetic fibres supplying the shoulder joint. The new approach proved to be simple, highly successful, and reproducible.
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Letter Case Reports
Life-threatening tension pneumocephalus after nitrous oxide anaesthesia.