British journal of anaesthesia
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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.
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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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Study of patients who exhibit only limited morphological abnormality yet present difficulty with direct laryngoscopy is facilitated by a standard intubating position. The "Angle Finder" instrument allows implementation of a simple reproducible geometric standard which is applied easily in formal research work and in clinical practice and teaching. ⋯ Initially, the standard was derived from a review of the literature, then validated in a study of the intubating practices of 10 senior anaesthetists. A more detailed study of 10 normal volunteers confirmed reproducibility and, for nine patients with a history of difficult direct laryngoscopy, the standard was shown to be appropriate.