British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Priming of cardiopulmonary bypass with human albumin or Ringer lactate: effect on colloid osmotic pressure and extravascular lung water.
We have undertaken a randomized study on 20 patients undergoing coronary artery bypass surgery in order to determine the influence of cardiopulmonary pump prime solutions on colloid osmotic pressure and extravascular lung water. Crystalloid priming with Ringer lactate was compared with an albumin solution of nearly physiological colloid osmotic composition (4%). ⋯ The more pronounced decrease in colloid osmotic pressure and in transcapillary gradient (difference between colloid osmotic pressure and pulmonary capillary wedge pressure) in the Ringer lactate group was associated with a significant increase in extravascular lung water (by 60%) in the postoperative period; the human albumin group, however, showed only a slight tendency to increased lung water. There were no differences in haemodynamic or respiratory states after operation.
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A prospective study of unexpected, difficult laryngoscopy was carried out. During a 7-month period, all general surgery patients in whom the trachea was intubated were assessed; only those with obvious neck pathology were excluded. Ease or difficulty of laryngoscopy was graded by a standard method. ⋯ There were significant differences in the results recorded by different individuals; this did not correlate with seniority or with the type of surgery. Four factors have been identified which help to explain these discrepancies. These findings are analysed in relation to the training of junior staff, with particular reference to obstetric anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of extradural ropivacaine and bupivacaine.
Ropivacaine, a new long acting amide type local anaesthetic, was compared with bupivacaine in a randomized double-blind study. One hundred and ten patients undergoing extradural anaesthesia received a test dose of 3 ml of 1% lignocaine with adrenaline which was followed by 15 ml of one of five solutions: 0.5, 0.75 or 1.0% ropivacaine or 0.5 or 0.75% bupivacaine. There was little difference between the groups with respect to speed of onset or sensory block. ⋯ Increasing concentration of both drugs resulted in greater degree and longer duration of motor block. Ropivacaine produced a slower onset, shorter duration and less intense motor block than the same concentration of bupivacaine. The cardiovascular changes were similar in all groups.