British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Maximum FIO2 during caesarean section.
Forty patients undergoing elective and emergency Caesarean section (excluding severe fetal distress) were divided into four groups to receive 50% oxygen, 50% nitrous oxide, and 0.5% halothane (group 1, controls) or 100% oxygen supplemented by 1.5 x MAC of halothane, enflurane or isoflurane (groups 2,3,4, respectively) reducing to 1.0 x MAC 5 min after induction. The umbilical venous PO2 in the oxygen-only groups was higher than in the oxygen-nitrous oxide groups, this difference reaching statistical significance when the patients in the oxygen-only groups were combined. ⋯ Improved cardiovascular stability was demonstrated in the elective high-oxygen groups. The technique is safe and warrants further study, since there are no important ethical objections.
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Comparative Study
Comparison of neuromuscular blockade in the diaphragm and the hand.
Neuromuscular blockade was recorded in the diaphragm and in the adductor pollicis muscle using unilateral supramaximal stimulation of phrenic and ulnar nerves and measurement of the mechanical effect of each. After administration of atracurium 0.4-0.5 mg kg-1 to 10 patients, both onset and recovery of neuromuscular blockade in the diaphragm occurred before that in adductor pollicis and there was a linear relationship between recovery in diaphragm and adductor pollicis. After administration of vecuronium 0.08-0.1 mg kg-1 to a further 10 patients, paralysis occurred in the diaphragm before adductor pollicis in all except one patient, in whom it occurred simultaneously. Reappearance of adductor pollicis twitch occurred in six patients after all four twitches had returned in the diaphragm, but the rate of recovery of twitch height in the diaphragm was more rapid than in adductor pollicis in every patient.
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Comparative Study
Propofol reduces seizure duration in patients having anaesthesia for electroconvulsive therapy.
Twenty-five patients received either methohexitone 1.0 mg kg-1 or propofol 1.3 mg kg-1 to induce anaesthesia during two separate electroconvulsive therapy (ECT) treatments. A forearm was isolated before administration of suxamethonium 0.5 mg kg-1, so that unmodified seizure duration could be measured. ⋯ Median (quartile deviation) duration of seizure was reduced significantly after propofol (19.0 (9.0) s), compared with after methohexitone (33.0 (7.8) s). Therefore propofol may not be an appropriate anaesthetic for ECT because of its adverse effect on seizure duration.