British journal of anaesthesia
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Comparative Study
Downward movement of syringe pumps reduces syringe output.
We studied how lowering a syringe pump and changing the outflow pressure could affect syringe pump output. We experimentally reduced the height of three different syringe pump systems by 80 cm (adult setting) or 130 cm (neonatal setting), as can happen clinically, using five flow rates. We measured the time of backward flow, no flow and the total time without flow. ⋯ The compliance of the different syringe pumps and their infusion systems was linearly correlated with the effective time without infusion (r2=0.863, P<0.05). We conclude that the height of the syringe pumps should not be changed during transportation. If vertical movement of the syringe pump is necessary, the drugs should be diluted so that the flow rate is at least 5 ml h(-1).
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Randomized Controlled Trial Clinical Trial
Orally administered clonidine significantly reduces pain during injection of propofol.
We examined the analgesic effects of orally administered clonidine on pain induced by injection of propofol (Diprivan; 2,6-diisopropyl phenol). Female patients (n=81) were randomly allocated to one of two groups: oral clonidine (5.5 microg kg(-1)) followed by i.v. propofol and a control group given placebo followed by i.v. propofol. The median pain score in the group receiving clonidine, using a four-point scale (0=no pain, 1=minimal pain, 2=moderate pain, 3=severe pain) was 1 (0-2), significantly lower than in the control group [2 (1-3), median (25-75 percentiles), P<0.001].
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Case Reports
Intramuscular ketamine in a parturient in whom pre-operative intravenous access was not possible.
We describe the management of a 23-yr-old woman with extreme needle and mask phobia, presenting for an emergency Caesarean section for fetal distress. She also suffered from spina bifida cystica with no sensation from mid thigh. Regional anaesthesia, rapid sequence induction, and gaseous induction were not possible. She was managed successfully with i.m. ketamine followed by a more conventional anaesthetic technique.
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Case Reports
Xenon anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome.
There are few reports on anaesthesia for patients with Eisenmenger's syndrome requiring non-cardiac surgery and none of the use of xenon. We describe the use of xenon with a closed-circuit system in a patient with Eisenmenger's syndrome having a laparoscopic cholecystectomy.
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Oesophageal Doppler monitoring (ODM) has been advocated as a non-invasive means of measuring cardiac output (CO). However, its reliance upon blood flow measurement in the descending aorta to estimate CO is susceptible to error if blood flow is redistributed between the upper and lower body. We hypothesize that lumbar epidural anesthesia (LEA), which causes blood flow redistribution, causes errors in CO estimates. ⋯ ODM measured a greater increase in CO after LEA (delta=+1.71 (1.19) litre min(-1) (mean (SD)) compared with TD (delta=+0.51 (0.70) litre min(-1)). We conclude that following LEA, measurements with the Oesophageal Doppler Monitor II overestimate CO and show unacceptably high variability. Blood flow redistribution may limit the value of ODM.