British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Autologous blood transfusion in total knee replacement surgery.
We compared allogeneic blood usage for two groups of patients undergoing total knee replacement surgery (TKR). Patients were randomized to receive either their post-operative wound drainage as an autotransfusion (n=115) after processing or to have this wound drainage discarded (n=116). Allogeneic blood was transfused in patients of either group whose haemoglobin fell below 9 g dl(-1). ⋯ There was a higher incidence of infection requiring intervention in the allogeneic group (P<0.036). Total patient costs were Pound Sterling 113 greater in the autotransfusion group. We conclude that in this type of surgery post-operative cell salvage is a safe and effective method for reducing allogeneic blood use.
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Recent evidence has suggested that the rate of uptake of inhalational anaesthetic is constant during maintenance of anaesthesia, contrary to the predictions of multi-compartment uptake models. We measured isoflurane uptake using a totally closed anaesthetic system during up to 10 h of stable anaesthesia for maxillo-facial surgery on 12 adult patients. Liquid isoflurane was injected into the system under computer control to produce an end tidal concentration of 1.3 MAC of isoflurane. ⋯ Anaesthetic usage for a 70 kg patient was 0.44e(-0.51t)+0.044e(-0.013t)+0.058e(-0.00098t) ml min(-1) of liquid isoflurane, where t is duration of anaesthesia in minutes. There was a continuing reduction in anaesthetic requirement even at the end of the period of study that was statistically significant. These data do not support the notion that isoflurane uptake is constant during stable maintenance of anaesthesia but is compatible with the conventional multi-compartment model of anaesthetic uptake and distribution.
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Myasthenia gravis is an uncommon autoimmune disease resulting in destruction of the postsynaptic nicotinic receptors at the neuromuscular junction. We describe a 43-yr-old, 95 kg patient who presented for elective laparoscopic cholecystectomy. ⋯ Subsequent investigation led to a diagnosis of myasthenia gravis. We discuss the investigation, diagnosis, and subsequent management of such a patient and emphasize that tactile estimation of the train-of-four ratio is not a reliable indicator of adequate recovery of neuromuscular function.