British journal of anaesthesia
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Previous studies have reported that malignant hyperthermia susceptibility is caused in some families by inherited variation in a gene located on the short arm of chromosome 19 near to, or identical with, the ryanodine receptor gene (RYR1); this is expressed in skeletal muscle as a calcium release channel of the sarcoplasm reticulum. In other families, a gene in this location is excluded, but the locations of the genes involved have not yet been defined. ⋯ The results presented here strongly suggest that the gene for malignant hyperthermia susceptibility in one or more of these three British families is located in the same region of chromosome 19q, although further work is required to decide whether or not the RYR1 gene itself is causative in these families. As genetic heterogeneity could not be excluded, we cannot yet recommend the use of DNA markers to replace in vitro contracture tests in the diagnosis of malignant hyperthermia susceptibility.
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Randomized Controlled Trial Comparative Study Clinical Trial
Preoperative drinking does not affect gastric contents.
We have compared the effect of allowing free clear fluids until the time of oral premedication with conventional preoperative fasting. In a prospective, randomized trial, the residual volume and pH of gastric contents after induction of anaesthesia were measured in 100 elective surgical patients allocated randomly to a group in whom the intake of free clear fluids up to the time of premedication was measured (mean 388 ml in 6 h before surgery) or a control group who were fasted for 6 h. ⋯ Problems with aspiration or regurgitation were not encountered. We believe that allowing elective surgical patients to drink clear fluids until 2 h before anaesthesia may enhance patient comfort without compromising safety.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of alfentanil with suxamethonium in facilitating nasotracheal intubation in day-case anaesthesia.
We have performed a prospective study in 100 adults (ASA I or II) undergoing day-case dental extraction to compare the conditions for intubation and the postoperative sequelae of suxamethonium and alfentanil as adjuncts to propofol. The patients were allocated randomly to two groups comparable in age, sex and weight. Successful intubation was achieved in 100% of the suxamethonium group and 90% of the alfentanil group. ⋯ The proportion of patients who developed sore throat was also less in the alfentanil group than in the suxamethonium group (P < 0.05). The proportion of patients who complained of nausea in the two groups was not significantly different. We conclude that alfentanil, as an adjunct to propofol to facilitate tracheal intubation, is more acceptable to patients than suxamethonium in anaesthesia for day-case surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the reinforced laryngeal mask airway and tracheal intubation for adenotonsillectomy.
One-hundred and four patients were allocated randomly to receive anaesthesia for adenotonsillectomy via either a reinforced laryngeal mask airway or tracheal tube. Airway maintenance and protection were assessed during and after operation. ⋯ In children, recovery was less eventful in the laryngeal mask airway group, with less airway obstruction (P < 0.001) and better airway acceptance (P < 0.05). The reinforced laryngeal mask airway provided a clear, secure airway until recovery of protective reflexes.