Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Premedication with midazolam in children. Effect of intranasal, rectal and oral routes on plasma midazolam concentrations.
We report a study performed to compare the time and plasma drug concentrations necessary to achieve a similar state of sedation after midazolam premedication given by various routes in children of 2-5 years old. Children were randomly allocated to one of three groups to receive midazolam 0.2 mg.kg-1 given intranasally, 0.5 mg.kg-1 given orally or 0.3 mg.kg-1 given rectally. Sedation was measured regularly until venepuncture was possible in a cooperative child. ⋯ Duration of surgical procedures, and of propofol infusion, and recovery from anaesthesia was similar for the three groups. The only problem arose in a 30-month-old boy in the intranasal group who developed respiratory depression with a plasma midazolam concentration of 169 ng.ml-1. Intranasal midazolam is an excellent alternative for rapid premedication provided that respiratory monitoring is used.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of vital capacity breath and tidal breathing techniques for induction of anaesthesia with high sevoflurane concentrations in nitrous oxide and oxygen.
Vital capacity breath and tidal breathing techniques were compared for induction of anaesthesia with 7.5% sevoflurane in nitrous oxide, and oxygen. Thirty five subjects were randomly assigned to a vital capacity breath group (19) or to a tidal breathing group (16). The mean time for induction was faster with vital capacity breath (41 s) than with tidal breathing (52 s, p < 0.05). ⋯ Coughing was seen in a quarter of the subjects in the tidal breathing group and in one subject of the vital capacity breath group. The vital capacity group showed excellent characteristics: rapid, and pleasant induction without premedication. We conclude that the vital capacity breath technique is necessary for the inhalation induction of anaesthesia; it provides enough overpressure to allow the subject to pass reliably and rapidly through the initial stages of excitement.
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Comparative Study Clinical Trial Controlled Clinical Trial
Edrophonium as an antagonist of vecuronium-induced neuromuscular block in the elderly.
Train-of-four stimuli were applied to the ulnar nerve using an accelograph in 10 elderly patients (aged 70-82 years) and 10 younger patients (aged 27-54 years). Anaesthesia was induced with thiopentone 5 mg.kg-1 and was maintained with nitrous oxide (66%) oxygen and sevoflurane (1 MAC). Vecuronium 0.1 mg.kg-1 was used for paralysis, and reversed with intravenous edrophonium 0.75 mg.kg-1 and atropine 0.015 mg.kg-1 when the train-of-four ratio returned to 25%. ⋯ The reversal times from 25% to 75% of the train-of-four ratio after the administration of edrophonium were 210.0 (SD 136.7) s and 177.0 (SD 100.4) s in the elderly and younger patients, respectively. There was no statistically significant difference between them. The authors were unable to show that healthy elderly patients differ significantly from younger patients in the neuromuscular blocking effect of vecuronium and the reversal effect of edrophonium.
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Consecutive obese (n = 53) and non-obese parturients (n = 609) were prospectively evaluated during labour to analyse the influence of maternal obesity on labour pain and outcome. Excessive pre-pregnancy weight was classified as a body mass index of 30 kg.m-2 or more. Pain intensity was measured using an 11 point visual scoring scale. ⋯ After delivery, obese women were significantly more content with the pain relief received; only 12% vs 23% in the control group complained of poor pain control (p = 0.03). In this study, obesity and increased fetal size did not complicate labour or its outcome. Critical patient assessment should be emphasised, however, due to the physiological and medical problems present in obese parturients.
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Case Reports
Cardiac arrest and resuscitation of a 6-month old achondroplastic baby undergoing neurosurgery in the prone position.
We describe the case of a 6-month-old achondroplastic baby who underwent foramen magnum decompression to relieve congenital cervical cord compression. During the procedure, acute hypotension occurred secondary to cord compression, and following attempts to alleviate this, torrential haemorrhage ensued and air was entrained into the circulation through large venous channels in the surgical field. This resulted in an asystolic cardiac arrest from which the baby was resuscitated whilst remaining in the prone position. ⋯ In total, 11 min elapsed before an adequate spontaneous cardiac output was re-established. The procedure was abandoned and the patient transferred to the intensive care unit for postoperative management. An electroencephalogram performed after 24 h was reported as normal, and clinically the child made a full neurological recovery.