British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Partly exhausted soda lime or soda lime with water added, inhibits the increase in compound A concentration in the circle system during low-flow sevoflurane anaesthesia.
We performed low-flow sevoflurane anaesthesia at a flow rate of 1 litre min-1 in three groups (n = 8 each) using 600 g of fresh soda lime (control group), 600 g of soda lime with 60 ml of water added (water group) or 600 g of soda lime saturated with carbon dioxide, that is partly exhausted soda lime (carbon dioxide group). Degradation products in the system were measured hourly. ⋯ The mean maximum concentration of compound A was significantly higher in the control group (mean 16.0 (SD 5.0) ppm) than in the water (1.4 (1.0) ppm) or carbon dioxide (4.0 (1.8) ppm) group, and the maximum temperature of the soda lime was significantly lower in the carbon dioxide group (30.7 (3.5) degrees C) than in the control (43.4 (1.8) degrees C) or water (40.8 (1.8) degrees C) group (P < 0.05). The use of partly exhausted soda lime or soda lime with water added reduced compound A concentrations in the system during low-flow sevoflurane anaesthesia.
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Multicenter Study Clinical Trial
The intubating laryngeal mask. II: A preliminary clinical report of a new means of intubating the trachea.
We have assessed the efficacy of a new laryngeal mask prototype, the intubating laryngeal mask airway (ILMA), as a ventilatory device and blind intubation guide. The ILMA consists of an anatomically curved, short, wide bore, stainless steel tube sheathed in silicone which is bonded to a laryngeal mask and a guiding handle. It has a single moveable aperture bar, a guiding ramp and can accommodate an 8 mm tracheal tube (TT). ⋯ In 10 of 13 (77%) of these patients, no resistance was encountered and the trachea was intubated at the first attempt; three of 13 (23%) patients required one adjusting manoeuvre. Tracheal intubation required significantly fewer adjusting manoeuvres in patients with a predicted or known difficult airway (P < 0.05). We conclude that the ILMA appeared on initial assessment to be an effective ventilatory device and intubation guide for routine and difficult airway patients not at risk of gastric aspiration.
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A new prototype of the laryngeal mask airway (LMA), the intubating laryngeal mask airway (ILMA), was used to facilitate tracheal intubation in 100 fasted patients presenting for elective surgery. Alignment of the ILMA with the larynx was assessed fibreoptically before intubation without the investigator performing the intubation being aware of the view score. ⋯ Of the seven intubation failures, five occurred in the first 20 patients. Conventional connection to the breathing system and ventilation of the lungs of the patients were possible throughout the intubation procedure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of methohexitone and propofol with or without alfentanil on seizure duration and recovery in electroconvulsive therapy.
We have studied the effects of methohexitone and propofol with and without alfentanil on seizure duration and recovery in this observer-blinded, prospective, randomized, crossover study involving 24 patients undergoing electroconvulsive therapy (ECT). Each patient had four treatment sessions, and received the following four i.v. regimens in random order: methohexitone 0.75 mg kg-1, methohexitone 0.50 mg kg-1 and alfentanil 10 micrograms kg-1, propofol 0.75 mg kg-1, propofol 0.50 mg kg-1 and alfentanil 10 micrograms kg-1. Additional methohexitone or propofol was given as needed in 10-20-mg increments until loss of consciousness. ⋯ Recovery time was statistically shorter in patients receiving propofol compared with methohexitone-alfentanil and methohexitone alone. Alfentanil with a reduced dose of methohexitone or propofol provided unconsciousness and increased seizure duration in patients undergoing ECT. We conclude that the combination of methohexitone with alfentanil is a good regimen for ECT, especially for patients with short seizure duration.
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Randomized Controlled Trial Clinical Trial
Prevention of hypothermia by cutaneous warming with new electric blankets during abdominal surgery.
We have evaluated the efficacy of new electric warming blankets, which meet the requirements of the international standard for perioperative electrical and thermal safety, in preventing intraoperative hypothermia. We studied 18 patients undergoing abdominal surgery, allocated to one of two groups: in the control group, there was no prevention of intraoperative hypothermia (n = 8) and in the electric blanket group, two electric blankets covered the legs and upper body (n = 10). ⋯ Five patients shivered in the control group compared with one in the electric blanket group (P < 0.05). We conclude that cutaneous warming with electric blankets was an effective means of preventing intraoperative hypothermia during prolonged abdominal surgery.