British journal of anaesthesia
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We have examined the effect of varying end-expiratory lung volume on carbon dioxide elimination in 10 mongrel dogs undergoing conventional mechanical ventilation at 12 b.p.m. and forced diffusion ventilation (FDV) at 6 Hz and 50 Hz and continuous flow. End-expiratory volumes were altered by changing the pressure in a plethysmographic box in which the dogs underwent ventilation. ⋯ The results indicated that more carbon dioxide was eliminated at low lung volumes and this was most pronounced with HFV at 50 Hz and continuous flow. It is postulated that changes in airway geometry and different lung volumes may alter the distance between the gas interface in the conductive airways and the respiratory zone and so alter the efficiency of ventilation during FDV.
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Comparative Study
Propofol for induction and maintenance of anaesthesia: comparison between younger and older patients.
The propofol requirements for the induction and maintenance of anaesthesia were compared in groups of younger and older patients. Side effects, influence on the cardiovascular system and recovery times were compared between 20 unpremedicated ASA I-III, 25-40-yr-old patients and 20 65-80-yr-old patients all scheduled to undergo elective surgery. After induction with propofol, anaesthesia was maintained with a continuous infusion of the drug. ⋯ Side effects were more pronounced in the younger patients. Influences on the cardiovascular system were definite, but mild. The younger patients awoke sooner: 7.8 v. 14.3 min (P less than 0.01) after the discontinuation of the infusion of propofol.
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A new method has been developed to measure end-tidal carbon dioxide partial pressure (PECO2) during high frequency jet ventilation (HFJV). A digital flow controller incorporated in a computerized high frequency jet ventilator was used to deliver either a single deep breath or a series of three deep breaths. On user request, HFJV was interrupted and the deep breaths delivered, after which HFJV was resumed. ⋯ In all the dogs, within an optimum Pdb range of 5-10 cm H2O, PECO2 during the first deep breath was found to be similar (+/- 0.2 kPa) to the PaCO2 immediately before the onset of deep breaths. Deep breaths delivered above or below the optimum Pdb range resulted in a decrease in the ratio PECO2:PaCO2. The frequency of jet ventilation (12-200 b.p.m.) before the onset of the deep breaths did not affect PECO2:PaCO2.
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Randomized Controlled Trial Comparative Study Clinical Trial
In vivo assessment of percutaneous local anaesthetic preparations.
This study has demonstrated greater efficacy of a new percutaneous amethocaine preparation relative to Eutectic Mixture of Local Anaesthetics (EMLA). Initially, a double-blinded trial was undertaken on each preparation individually against placebo, as the recommended method of application was different for EMLA (2.5 g applied for 60 min under an occlusive dressing) and the amethocaine formulation (0.5 g applied for 30 min). Thereafter, the two preparations were compared directly, in a double-blinded study using a standardized application for both formulations. ⋯ The amethocaine preparation produced significant anaesthesia (chi-square, P less than 0.001) after 30 min application. Furthermore, the amethocaine formulation demonstrated both increased rapidity of action and increased duration of effect, as determined by a two-tailed unpaired t test, in comparison with EMLA when application times of both 30 and 60 min were used for each preparation. The results of this study indicate that the amethocaine preparation provided more rapid and prolonged anaesthesia than EMLA.
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A case is reported of an unusual complication in which acute gastric dilatation occurred in an incarcerated hiatus hernia, resulting in left ventricular failure in the postoperative period. Failure to recognize this gave rise to concern when the patient re-presented for further surgery.