Anaesthesia
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A new prototype laryngeal mask airway is described which incorporates a second mask to isolate the upper oesophagus and a second dorsal cuff to increase the seal against the glottis. We have made a within-patient comparison of seal pressures between the prototype and standard laryngeal mask airway in 20 patients, and determined if the prototype facilitates functional isolation of the glottis and upper oesophagus. ⋯ Ease of insertion and incidence of pharyngeal morbidity appeared similar to the standard laryngeal mask, but were not formally tested. The prototype laryngeal mask airway exhibits potentially useful new features which justify further evaluation and development.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery. A comparison of thoracic and lumbar routes.
Thirty-three patients who had undergone elective open cholecystectomy were studied in a prospective, randomised comparison of thoracic (n = 17) and lumbar (n = 16) epidural routes of administration of a mixture of bupivacaine 0.2% with fentanyl 10 micrograms.ml-1 for postoperative pain. Pain relief, cardiovascular stability, respiratory rate and side effects were assessed by a 'blinded' observer at specific times in the 24 h study period. ⋯ The incidence of side effects attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p < 0.05). This study supports the use of the thoracic epidural route for postoperative pain management after upper abdominal surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography.
We evaluated possible differential effects of vecuronium on the thumb and great toe using two types of neuromuscular transmission monitor. Train-of-four stimuli were simultaneously applied to the ulnar nerve and tibial nerves using cutaneous electrodes. The responses were quantified with accelographs (thumb and left great toe) and an electromyograph (right great toe). ⋯ The differences between the thumb and great toe were statistically significant during both types of anaesthesia when measured with the accelograph (p < 0.01). The time from completion of maximal block to 25% recovery of twitch height in the thumb was significantly longer than that of the great toe as measured by accelography during both types of anaesthesia (p < 0.05). In contrast, there were no statistically significant differences between time to maximum block and 25% recovery of twitch height of the thumb as measured by accelography compared to the values measured for the great toe using electromyography during either anaesthetic technique.(ABSTRACT TRUNCATED AT 250 WORDS)