British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Misplacement of subclavian venous catheters: importance of head position and choice of puncture site.
We have investigated the frequency of misplacement of subclavian catheters in 200 consecutive patients admitted to the Intensive Care Unit. The patients were allocated randomly to an attempt at infraclavicular cannulation of the right or left subclavian vein with the head turned either towards or away from the selected side, giving four groups. ⋯ Misplacement into the internal jugular vein occurred in 10 (5.4%) patients. No statistically significant difference (P less than 0.05) was demonstrated between the four groups.
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Randomized Controlled Trial Clinical Trial
Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace.
Spinal anaesthesia was compared in 40 obese patients (increased body mass index (BMI] and 40 patients with normal BMI when 3 ml of plain 0.5% bupivacaine was injected at either the L3-4 or L4-5 interspace. More extensive cephalad spread of sensory block was achieved in patients with increased BMI compared with patients with normal BMI after injection at both L3-4 and L4-5 (P less than 0.05). ⋯ Good anaesthesia was produced in all patients for orthopaedic surgery of the lower extremity. In an obese patient it is recommended that plain bupivacaine be administered at L4-5 instead of L3-4 when extensive spread of the block is to be avoided.
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A 38-yr-old woman who was 35 weeks pregnant presented with a subarachnoid haemorrhage, secondary to a ruptured anterior communicating artery aneurysm. Following initial recovery, she subsequently underwent simultaneous elective Caesarean section and clipping of the aneurysm. The anaesthetic management of the case is described and discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic effects of the phosphodiesterase inhibitor enoximone in comparison with dobutamine in esmolol-treated cardiac surgery patients.
In a randomized study, the haemodynamic effects of the new phosphodiesterase-III-inhibitor, enoximone, were compared with dobutamine in acutely beta-adrenoceptor blocked patients. Twenty patients scheduled for aorto-coronary bypass grafting suffering from tachycardia (heart rate (HR) greater than 100 beat min-1) were treated by infusion of esmolol, an ultra-short acting, selective beta 1-blocker. Twenty minutes after the start of esmolol, either enoximone 0.5 mg kg-1 as a bolus (n = 10) or dobutamine 5 micrograms kg-1 min-1 was administered. ⋯ Cardiac index (CI) was decreased also. Enoximone increased Cl (+35%) and dP/dtmax (+39%) significantly, while no change in dobutamine-treated patients was observed. Systemic vascular resistance increased only in the dobutamine group (+44%).