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
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.
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Thirty-two women underwent major gynaecological surgery with a midazolam-alfentanil total i.v. anaesthetic regimen. Adequacy of anaesthesia was assessed using a "pressure, rate, sweating and tears" (PRST) scoring system in conjunction with the isolated forearm technique (IFT). The IFT revealed that 72% of patients responded during surgery, but none had spontaneous, unprompted postoperative recall for the event. ⋯ Twenty patients, asked specifically during surgery to indicate the presence or absence of pain, experienced pain at some time during their surgical procedure. The PRST score could not be used to predict when a patient was awake. This low-dose i.v. anaesthetic technique cannot be recommended for general use.
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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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Comparative Study
Extra inspiratory work of breathing imposed by cricothyrotomy devices.
Using a lung model for spontaneous ventilation, we have assessed the additional work of inspiration imposed by a variety of cannulae ranging from the 12- and 14-gauge intravascular cannulae to the 8.0-mm i.d. adult tracheostomy tube. Work (W) ranged between 9 and 2262 mJ litre-1 and power (W) between 0.2 and 37.7 mW litre-1 min; the smallest values were obtained with the 8.0-mm i.d. adult tracheostomy tube and the 12- and 14-gauge intravascular cannulae gave the largest values. With any given cannula, W and W were influenced by ventilation (tidal volume and frequency) and ventilatory wave pattern of the analogue lung. The results obtained from the 12- and 14-gauge cannulae represent what is probably an excessive inspiratory workload, whereas the other four devices (Portex MiniTrach, 4.0, 6.0 and 8.0 tracheostomy tubes) may be suitable in the short term for relieving airway obstruction and compatible with spontaneous ventilation.