Anaesthesia
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An uncuffed nasotracheal tube for use in minor maxillofacial surgery has been developed using polyurethane. The suitability of this tube as an alternative to the existing soft red rubber and harder polyvinyl chloride materials has been assessed at four centres during anaesthesia for routine oral surgery. The tube was found to be satisfactory.
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Randomized Controlled Trial Clinical Trial
Recovery of mivacurium block with or without anticholinesterases following administration by continuous infusion.
Thirty patients received a bolus dose of 0.2 mg.kg-1 of mivacurium followed by an infusion during anaesthesia with thiopentone, fentanyl and halothane. Neuromuscular block was monitored using train-of-four stimulation and mechanomyography and the block maintained to keep the first response in the train-of-four (T1) at 10% of control. At the end of surgery the patients were randomly allocated to reversal with neostigmine or edrophonium or to spontaneous recovery. ⋯ The times taken for T1 to reach 25, 75 and 90% of control and for the train-of-four ratio to reach 0.7 were significantly shorter (p < 0.05 to 0.001) with neostigmine and edrophonium compared to the spontaneously recovering group. The average (SD) times for attaining the train-of-four ratio of 0.7 were 7.0 (1.2), 6.8 (1.4) and 13.5 (2.3) min respectively for neostigmine, edrophonium and spontaneously recovering groups. There were no differences between endrophonium and neostigmine in any of the recovery times.
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Noise in the operating theatre, recovery room and intensive care unit is above internationally recommended levels. The psychological and physiological effects of noise are reviewed. Equipment and conversation among the staff are major sources of noise in these areas. Equipment design, modification of nursing care procedures, and increased awareness of noise created by the staff may be effective in reducing noise pollution in these areas.
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We measured continuously cerebral venous oxyhaemoglobin saturation (SjvO2) using a 4F fibreoptic catheter in 11 patients scheduled for elective myocardial revascularisation. The aims of this study were to assess the Oximetrix 3 computer and Opticath 40 cm catheter during moderate hypothermic cardiopulmonary bypass, and identify epochs of cerebral hypoperfusion (SjvO2 < 54%). Radial artery pressure, brain electrical activity, arterial and cerebral venous oximetry (dual oximetry), end-tidal CO2 and nasopharyngeal temperature were recorded continuously in each patient. ⋯ In 10 patients SjvO2 decreased below normal at rewarming and myocardial reperfusion: mean lowest value 37%, range 19%-55%. Reduced SjvO2 were associated with a decrease in perfusion pressure (r = 0.292, 80 DF, p = 7.7* 10(-3)), and with an increase in nasopharyngeal temperature (r = -0.46, 115 DF, p = 2.7* 10(-7)) after moderate hypothermia. The Oximetrix 3 computer and Opticath 40 cm catheter provided reliable and accurate continuous monitoring of SjvO2 during nonpulsatile cardiopulmonary bypass involving hypothermia with haemodilution and identified rewarming as the period of greatest risk of global cerebral hypoperfusion.
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Randomized Controlled Trial Clinical Trial
Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases.
The use of rocuronium (Org 9426) as a single bolus followed by an infusion was assessed in 50 patients under anaesthesia with nitrous oxide-oxygen and halothane. Neuromuscular block was monitored using train-of-four stimulation and recording the force of contraction of the adductor pollicis muscle. Rocuronium was administered in an initial bolus dose of 0.45 mg.kg-1 followed by an infusion adjusted manually to maintain the T1, the first response in the train-of-four, at 10% of control. ⋯ Three patients in the group receiving edrophonium at T1 of 10% and one in the group receiving neostigmine at T1 of 25% failed to attain a train-of-four ratio of 0.7. It is concluded that rocuronium can be administered as a continuous infusion for stable neuromuscular block. Neostigmine may be a more reliable antagonist of deep block, whereas edrophonium is advantageous when there is a greater spontaneous recovery.