Anaesthesia
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The effects of xenon anaesthesia on myocardial function and cerebral blood flow velocities were investigated with transoesophageal echocardiography and transcranial Doppler sonography. Seventeen ASA 1 patients undergoing open cholecystectomy (n = 16) or abdominal hysterectomy (n = 1) were studied. Anaesthesia with 65% xenon in oxygen was induced by ventilating the lungs through a circle system with minimal fresh gas flow. ⋯ There was no significant change after 5, 10 and 15 min of xenon anaesthesia. Cerebral blood flow velocities were unchanged during the first 5 min of xenon anaesthesia, but were significantly increased in the left and right middle, and the right anterior, cerebral arteries after 15 and 30 min (n = 16) (p < 0.05). In conclusion, xenon anaesthesia had no adverse effect on myocardial function, but probably increased cerebral flood flow.
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Clinical Trial
An evaluation of a new self-adhesive patch preparation of amethocaine for topical anaesthesia prior to venous cannulation in children.
A new preparation of amethocaine in the form of a self-adhesive patch, designed to provide topical cutaneous anaesthesia prior to venous cannulation, was evaluated in an open study of 189 children. The new preparation of amethocaine was in place for a mean time of 48 min (SD 3.9). Eighty percent of patients had a satisfactory degree of analgesia for venous cannulation. ⋯ Eight percent of patients had slight itching and 1% had moderate itching at the site of application. There was a clinical impression that venous dilatation made cannulation easier than with EMLA cream. These results suggest that this convenient preparation of amethocaine is highly effective at providing adequate topical cutaneous anaesthesia with a short onset time and a low incidence of minor side effects with no evidence of systemic toxicity.
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Laryngeal mask airway cuff inflation pressures were measured when inflated with the same volume of gas firstly in free space and then in position in the pharynx. A large difference in these pressures was observed and this was related to pharyngeal mucosal perfusion pressure. ⋯ This effect could, however, be reversed if inspired gas was used to inflate the mask cuff. We conclude that care must be taken when inflating the laryngeal mask cuff if postoperative morbidity is to be avoided and also that it may not be necessary to use as high a volume of inflating gas as has been recommended during spontaneous respiration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of 2-chloroprocaine and prilocaine for intravenous regional anaesthesia of the arm: a clinical study.
In a double-blind, randomised study of patients scheduled for minor hand surgery 0.5% 2-chloroprocaine (n = 30) and 0.5% prilocaine (n = 30) in a volume of 40 ml were compared for intravenous regional anaesthesia. The onset of sensory and motor block and recovery of sensory block were determined, and the occurrence of side-effects was noted. Twenty-four patients in the 2-chloroprocaine group and 17 in the prilocaine group developed complete sensory block by 15 min after injection (p < 0.05). ⋯ Venous irritation and/or urticaria after tourniquet release was observed on 10 occasions in those receiving 2-chloroprocaine and twice in those receiving prilocaine. An increase in heart rate of > 20% above control values occurred in three patients, all of whom had been given 2-chloroprocaine. Clinically, local anaesthetic properties of 0.5% 2-chloroprocaine and prilocaine were similar, but there were more side-effects with the former drug.
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Randomized Controlled Trial Comparative Study Clinical Trial
Atelectasis and oxygenation in major surgery with either propofol with or without nitrous oxide or isoflurane anaesthesia.
Forty-two patients undergoing major colonic surgery were assigned at random to receive isoflurane-fentanyl anaesthesia with nitrous oxide in oxygen, propofol-fentanyl anaesthesia with air in oxygen or propofol-fentanyl anaesthesia with nitrous oxide in oxygen. The groups were comparable in demographic data. Atelectases were identified, and the area measured by computerised tomography of the chest 203 +/- 69 min after extubation, and oxygenation was determined by arterial blood gas samples taken during operation at 30, 60, 90 and 120 min after extubation and on postoperative days 1, 2 and 3. ⋯ A significant decrease in PaO2 was found during the first 3 days after surgery, and was also the same in all groups. There was no correlation between area of atelectasis and postoperative PaO2. We conclude there is no difference in the incidence of postoperative atelectasis or oxygenation when using propofol, with or without nitrous oxide or isoflurane.