British journal of anaesthesia
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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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We have studied in 12 healthy male volunteers the effects of three different body positions (10 degrees head-down tilt, horizontal supine and supine with 50-cm leg elevation from the hip) on the spectral components of heart rate and finger plethysmographic amplitude variability. We have demonstrated the absence of any statistically significant difference in any measure of variability in the time of frequency domain for both of these measures between the three positions. We conclude that neither leg elevation nor 10 degrees head-down tilt is associated with any significant alteration in the dominant parasympathetic cardiac control in comparison with the resting supine position.
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We studied 60 children undergoing neurosurgical procedures in the sitting position. Routine monitoring included ECG, pulse oximetry, invasive arterial pressure, in particular mean arterial pressure (MAP), and right atrial pressure (RAP). Children were allocated to two groups. ⋯ Inflation of the MAST suit induced a dramatic increase in RAP and JBVP, reinforced by addition of PEEP. There was a strong positive relationship between RAP and JBVP. There were no deleterious side effects or differences between the two groups in peroperative blood product requirements or surgical general conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.