Anaesthesia
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Randomized Controlled Trial Comparative Study
Midazolam vs ondansetron for preventing postoperative nausea and vomiting: a randomised controlled trial.
We compared the prophylactic anti-emetic efficacy of midazolam and ondansetron in 90 patients scheduled for minor gynaecological (hysteroscopy) or urological (ureteroscopy) procedures planned to last 1-2 h under sevoflurane anaesthesia with spontaneous ventilation of the lungs via a laryngeal mask airway. Midazolam 2 mg or ondansetron 4 mg were administered intravenously 30 min before the end of surgery. ⋯ There were no significant differences in average sedation scores or pain scores. Treatment using ondansetron for anti-emetic prophylaxis did not provide a superior benefit compared to midazolam in the present study.
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Case Reports
Extracorporeal carbon dioxide removal using the Novalung in a patient with intracranial bleeding.
A neurosurgical patient who required repeated surgery for intracranial haematoma developed acute respiratory distress syndrome. Raised intracranial pressure proved difficult to manage whilst attempting to maintain optimal gas exchange. ⋯ Subsequently the requirements for both respiratory and cardiovascular support were reduced. The patient made a complete neurological recovery.
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Summary The aim of this prospective observational study was to document patterns of ventilation during manual hyperinflation by physiotherapists. Manual hyperinflation with a Mapleson-F system was performed on the same patients on two consecutive days. Patterns of ventilation were recorded using a heated pneumotachometer, pressure transducer and custom designed data acquisition and analysis systems. ⋯ All the physiotherapists achieved an increase in volume which was delivered within a safe and effective pressure range and without cardiovascular compromise. Most (26 out of 34 sessions) performed the technique in the way recommended for enhancing secretion clearance. This is the first study to document comprehensively the pattern of ventilation during manual hyperinflation and provides the basis for further clinical trials evaluating its effectiveness for secretion clearance and volume restoration.