British journal of anaesthesia
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Case Reports
Reversal of post-reperfusion coagulopathy by protamine sulphate in orthotopic liver transplantation.
We report details of two liver transplant procedures in which post-reperfusion coagulopathy was reversed by administration of protamine sulphate. Both procedures were uncomplicated until about 30 min after reperfusion of the graft, when the cut surfaces began to ooze blood. ⋯ A heparin-like effect was suspected. Protamine sulphate 50 mg was given i.v., resulting in cessation of bleeding and normalization of the thrombelastogram and KCT.
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Randomized Controlled Trial Clinical Trial
Convective warming after hypothermic cardiopulmonary bypass.
In a randomized, controlled study, we found that convective warming after hypothermic cardiopulmonary bypass did not accelerate the rate of warming of the body core or the time to tracheal extubation. The relationship between body core and shell temperature, however, was affected. ⋯ Convective warming was delivered using BairHugger (Augustine Medical Inc., MN, USA) and Warm Touch (Mallinckrodt Medical UK Ltd, Northampton, UK) blankets. There was no difference between the performance of each blanket when powered by the BairHugger 500 power unit set at its medium setting of 38 degrees C, and when chest drain and radial artery cannulation sites were left exposed for observation.
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Randomized Controlled Trial Clinical Trial
Withdrawal forces during removal of lumbar extradural catheters.
After performing successful continuous lumbar extradural conduction block, we investigated the effects of the extradural insertion technique (midline (M) or paramedian (P)) and patient position during extradural catheter removal (flexed lateral (L) or sitting (S)) on the force required to remove extradural catheters. One hundred parturients were allocated randomly to four groups: ML, MS, PL, PS. ⋯ However, more than 2.5 times as much force was required to remove the catheters when patients were in the flexed sitting compared with the lateral position (P < 0.005). For ease of removal of catheters from the lumbar extradural space we therefore strongly recommend the flexed lateral position.
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This study was designed to see if methylmethacrylate monomer bone cement released histamine in 13 patients undergoing total hip replacement surgery with a cemented prosthesis, compared with seven control patients receiving a cementless porous-coated prosthesis. Blood samples for plasma concentrations of histamine were obtained before the start of anaesthesia, immediately before insertion of methylmethacrylate bone cement into the shaft of the femur in the cemented fixation group or before insertion of the femoral component of the prosthesis in the cementless fixation group, and 15, 30 and 60 min after the start of implantation of the prosthesis. ⋯ There were no significant differences between groups. We conclude that methylmethacrylate bone cement does not release histamine during total hip replacement surgery.
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Historical Article
A brief historical review of non-anaesthetic causes of fires and explosions in the operating room.
Fires and explosions have occurred in the operating theatre for many years. Flammable inhalation anaesthetic agents were responsible for many incidents in the past, but these are no longer available in many countries. Other causes of fires and explosions still exist in the operating theatre and, from time to time, result in serious and occasionally fatal injury. ⋯ Adhesive skin drapes have resulted recently in two tragic deaths. The increasing use of laser therapy, particularly in ear, nose and throat surgery, and in oral surgery, has brought about a renewed awareness of the risk of fire. The relevant factors which should be borne in mind and the precautions which should be adopted when laser therapy is to be used in the airway are discussed.