Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of pre-induction glycopyrronium on the haemodynamic response of elderly patients to anaesthesia with propofol.
This study investigated whether pretreatment with glycopyrronium can attenuate the hypotension caused by anaesthesia of the elderly with propofol. Twenty elderly patients (77.1 +/- 2.44 years, mean +/- SEM) of ASA physical status 2 or 3 scheduled for elective urological procedures were given glycopyrronium 0 (n = 10) or 5 micrograms.kg-1 (n = 10) in a randomised, double-blind manner, 5 min before induction of anaesthesia with propofol infused at 600 ml.h-1 (average induction dose 1.7 +/- 0.06 mg.kg-1, mean +/- SEM) followed by maintenance with a propofol infusion at 10 mg.kg-1.h-1. Although glycopyrronium significantly increased heart rate (p less than 0.01, ANOVA), the decrease in blood pressure 2 and 5 min after induction was similar in both groups. The study had a power of 80% to detect a 20 mmHg difference in systolic arterial pressure between treatment groups with p less than 0.05.
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Randomized Controlled Trial Clinical Trial
Perineuronal morphine in intercostal block.
In a double-blind, randomised study the potential benefits of combining low-dose morphine with bupivacaine for intercostal nerve blocks for analgesia after biliary surgery were investigated. There was no significant improvement in pain scores or consumption of supplementary analgesics when morphine was added to bupivacaine. This investigation supports the findings of other workers who showed that perineural morphine was ineffective for postoperative pain relief.
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Oxygen delivery using nasal prongs was assessed using a lung model for spontaneous ventilation. The analogue lung was attached to a manikin, which provided a model of the 'face and pharynx' to which the nasal prongs were applied. ⋯ The study demonstrated enormous variability in the both the peak-inspired (26.3-90.0%) and end-expired concentrations (25.2-78.6%) of oxygen delivered to the trachea. There was a regular relationship between the ratio of peak inspiratory flows, expressed over fresh gas inflow and the end-expired oxygen concentrations which could allow estimation of inspired oxygen concentration.
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A previously fit patient underwent laparoscopic cholecystectomy. During the procedure arterial oxygen saturation fell and clinical examination revealed signs of a right pneumothorax confirmed by chest X ray. Aspiration of the pleural cavity and analysis of the gas removed showed it to be composed entirely of carbon dioxide. Possible mechanisms of entry of carbon dioxide into the pleural space are discussed.