British journal of anaesthesia
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A thirty-year review of the two major British anaesthetic journals, Anaesthesia and the British Journal of Anaesthesia, was undertaken. Overseas contributors accounted for 30% of the total articles published, with North America providing the greatest proportion. The remainder of the contributions came from the United Kingdom. ⋯ The North West Thames Region with 9%, contributed the single largest percentage of the British articles. There was a marked difference in the Regional contributions, not invariably linked to the size of the Authority or the number of University Departments. Over the thirty-year period there was a progressive increase in the number of published articles and an increase in the proportion of overseas contributors.
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The effect of isoflurane on cranial extradural pressure (EDP) was studied in 10 patients. In eight patients with normal intracranial pressure, the addition of 1.0% isoflurane to nitrous oxide plus fentanyl in oxygen anaesthesia, at physiological carbon dioxide tensions, did not cause any significant change in EDP; 1.5% resulted in a small but significant increase. ⋯ Mean arterial pressure (MAP) was decreased significantly at the higher isoflurane concentration. It was concluded that use of isoflurane is not contraindicated in patients with mass lesions, either at normocapnic or hypocapnic concentrations of carbon dioxide and would appear to be suitable for use in neurosurgical anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of alcuronium with edrophonium or neostigmine.
The reversal of alcuronium by edrophonium 1 mg kg-1 or neostigmine 35.7 micrograms kg-1 was compared in 23 patients undergoing elective ophthalmic surgery. Neuromuscular transmission was assessed by measuring the force of contraction of the adductor pollicis muscle in response to train-of-four supramaximal stimuli (2 Hz, 0.2 ms duration) delivered via surface electrodes to the ulnar nerve every 10 s. Anaesthesia was induced and maintained with Althesin, and patients were ventilated to normocarbia with 67% nitrous oxide in oxygen. ⋯ Recovery of the first contraction response of the train-of-four and of fade were more rapid after edrophonium. Although most patients were monitored for at least 30 min no re-curarization was seen. Comparison of the relative rates of recovery of the first contraction, and the response to train-of-four stimuli, suggests that edrophonium has a greater prejunctional effect than neostigmine.
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The results of early extubation after open heart surgery for congenital heart disease in 209 consecutive patients have been reviewed. No patient younger than 3 months of age, 52% of those between 3 and 12 months, and 88% of those older than 12 months had the tracheal tube removed in the operating theatre. Four patients required reintubation of the trachea, three because of respiratory difficulty and one because of cerebral oedema. ⋯ Twelve patients had PaO2 values less than 8.0 kPa after operation, despite adequate oxygen therapy. In four of these, this was related to persistent intracardiac shunting. It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk in carefully selected patients.