Anaesthesia
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A prototype valveless ventilator was attached by open deadspace tubing to a circle system and used to ventilate the lungs of 12 patients with low flows of anaesthetic gases for periods between 60 and 120 minutes during intra-abdominal surgery. Anaesthesia was induced with thiopentone and maintained with nitrous oxide 50% in oxygen and enflurane. ⋯ The measured mean inspired oxygen and nitrous oxide concentrations showed no significant variation throughout the low flow period of the study. This new low flow open circle ventilation system appears to offer some advantages in terms of safety and versatility over other systems which are discussed.
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Letter Case Reports
Pneumothorax after interpleural block in a spontaneously breathing patient.
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Randomized Controlled Trial Clinical Trial
Is crystalloid preloading useful in spinal anaesthesia in the elderly?
Sixty ASA grade 1 or 2 patients, aged 60 years or over, scheduled for surgery to the lower abdomen or lower limbs under spinal anaesthesia were allocated randomly to one of three treatment groups. Group A received 16 ml/kg of Ringer's acetate solution immediately before spinal anaesthesia, group B received 8 ml/kg and group C received no volume preload. Heart rate, arterial pressure and anaesthetic level were recorded by an independent observer. ⋯ The overall incidence of hypotension was 60%, when temperature sensation was blocked to T7 and above (n = 25). The number of patients with hypotension which required treatment increased as block height increased above T7; at a level of T4 or higher, all patients required ephedrine. Crystalloid preloading had no effect on the incidence of hypotension after spinal anaesthesia in fit, elderly patients.