Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the stress response to laryngoscopy. The Macintosh versus the McCoy blade.
The cardiovascular changes and catecholamine concentrations were compared in 20 patients before and after laryngoscopy with either the Macintosh or the McCoy laryngoscope blades. Following induction with fentanyl and thiopentone and muscle relaxation with vecuronium the vocal cords were visualised for 10 s with either the Macintosh or McCoy blade, chosen at random. Heart rate, arterial blood pressure and plasma noradrenaline and adrenaline concentrations were measured before, and at, laryngoscopy, and 1, 3 and 5 min later. ⋯ This was not observed with the McCoy blade. There was no change in plasma adrenaline concentrations with either blade during the 5 min after laryngoscopy when compared to the values before laryngoscopy. It is concluded that the stress response to laryngoscopy is less marked with the use of the McCoy blade and is probably due to a reduction in the force necessary to obtain a clear view of the larynx.
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The lung injury score is a semi-quantitative system used in the definition and grading of the acute respiratory distress syndrome. It is composed of two, three or four equally weighted components. One component is derived from the chest radiograph, which may contribute up to 50% of the total score. ⋯ Physician 1 significantly overscored (median score 4). The chest radiograph component of the lung injury score can be consistently assessed by radiologists, but significant variations may be introduced when assessed by other clinicians. This has significant implications for the use of the lung injury score in studies of adult respiratory distress syndrome and other studies which incorporate radiographic appearances in the definition.
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The purpose of this study was to determine current UK anaesthetic practice regarding the use of regional anaesthesia in the management of patients with placenta praevia presenting for Caesarean section. We asked the members of the Obstetric Anaesthetists Association to complete a postal questionnaire in which a range of clinical situations involving varying degrees of placenta praevia were presented. ⋯ A wide variety of clinical practice was demonstrated. Anaesthetists with two or more obstetric sessions were more willing to use regional anaesthesia for Caesarean section in the presence of placenta praevia in both elective and emergency situations associated with haemorrhage.
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Open-chest cardiac massage in humans to treat chloroform syncope was first performed by Niehans in Berne and Langenbuch in Berlin in the late 1880s. Closed-chest cardiac massage in humans was advocated by Koenig and Maass in Göttingen in the last two decades of the 19th century. The closed technique was used in Central Europe for several decades to treat chloroform syncope.
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Paravertebral analgesia is highly effective in blocking unilateral afferent input from the trunk, but its bilateral use does not appear to have been described. Eight patients undergoing major abdominal vascular surgery had pre-operative bilateral paravertebral catheters inserted. A dose of 25 ml of bupivacaine 0.5% divided between the two catheters provided the basis of an effective intra-operative analgesic regimen which was continued postoperatively by infusion of bupivacaine for 4 days. ⋯ Three patients were not admitted to the intensive care unit, where mean stays for the group was 10 h (range 0-24 h) and mean hospital stay was 10 days (range 7-14). There were no additional demands made on the nursing staff and no postoperative pain-related complications occurred. We conclude that bilateral paravertebral analgesia, as part of a balanced analgesic technique, is an alternative method of providing effective afferent blockage for major abdominal surgery.