British journal of anaesthesia
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Case Reports
Accidental subdural catheterization: radiological evidence of a possible mechanism for spinal cord damage.
We describe the inadvertent subdural insertion of a lumbar extradural catheter in a primiparous woman in labour. A small quantity of local anaesthetic resulted in extensive motor and sensory block. ⋯ We postulate that this could result in arterial compression or direct damage to the spinal nerve roots. Such a mechanism might explain some of the cases of permanent neurological damage associated with extradural analgesia.
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Randomized Controlled Trial Clinical Trial
A new technique for two-hand bag valve mask ventilation.
A method of bag valve mask ventilation (BVM) in which the resuscitator compresses the self-inflating bag between the open palm and body was compared with both standard single resuscitator and two-resuscitator BVM ventilation. Eighteen subjects ventilated a modified recording manikin using each method in random order. ⋯ The difference was greater in the nine subjects with small hands (mean 196 (103) ml). VT was less than with two-resuscitator ventilation (mean VT 953 (236) ml).
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We studied 110 patients older than 60 yr or aged 18-50 yr as separate groups in two stages to identify the smallest effective doses of propofol for induction of anaesthesia. In the elderly patients, in stage 1, at infusion rates of 25, 50 or 100 mg min-1 the mean (SD) doses administered were propofol 0.82 (0.14) mg kg-1, 1.22 (0.24) mg kg-1 and 1.65 (0.60) mg kg-1 and the induction times 140.1 (21.9) s, 103.2 (23.5) s and 69.4 (10.0) s, respectively. In stage 2, after induction with a fixed dose of 0.82 mg kg-1 as a bolus over 5 s or as an infusion at 25 mg min-1, the times for induction were 38.5 (14.0) s and 144.5 (36.6) s, respectively. ⋯ In stage 2, a fixed induction dose of 1.46 mg kg-1 resulted in induction times of 35.0 (8.5) s and 134.0 (26.8) s, respectively. In stage 2 of each age group, induction was achieved with smaller doses than those recommended previously and there was no difference in the number of patients in whom induction of anaesthesia was successful or in the measured cardiorespiratory variables between the two induction regimens. This suggests the latter effects are caused by the dose administered and not the rate of administration.