British journal of anaesthesia
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Case Reports
Rigid nasendoscope with video camera system for intubation in infants with Pierre-Robin sequence.
We describe an alternative intubation technique using a rigid nasendoscope and a video camera monitor system in two infants with Pierre-Robin sequence presenting for palatoplasty. After induction with an inhalational anaesthetic technique, the tracheas of the infants could not be intubated with direct laryngoscopy using a Wisconsin blade. ⋯ This technique proved to be simple, permitting a favourable view of the glottis. It should be considered for passing a tracheal tube through the vocal cords in infants who present with a difficult airway.
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Modern vaporizers are designed to deliver accurate and stable concentrations of volatile anaesthetic agents. Carrier gas composition may adversely affect the output from vaporizers. No previous study has tested helium in combination with sevoflurane vaporizers, a clinically useful combination especially in anaesthesia for upper airway obstruction. ⋯ Helium/oxygen mixtures can be used with these vaporizers without adversely affecting their performance.
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Arterial pressure waveform analysis is a new method for assessment of cardiac preload. Despite the close correlation of parameters derived by its use with the degree of blood loss, their relationship with more precise estimates of cardiac preload remains controversial. ⋯ During mechanical ventilation, dDown and the SPV may serve as minimally invasive indicators of preload. The retransfusion stage that follows significant blood loss may be associated with deterioration in LV function.
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Randomized Controlled Trial Clinical Trial
Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design.
Despite intensive research, the main causes of postoperative nausea and vomiting (PONV) remain unclear. We sought to quantify the relative importance of operative, anaesthetic and patient-specific risk factors to the development of PONV. ⋯ Volatile anaesthetics were the leading cause of early postoperative vomiting. The pro-emetic effect was larger than other risk factors. In patients at high risk for PONV, it would therefore make better sense to avoid inhalational anaesthesia rather than simply to add an antiemetic, which may still be needed to prevent or treat delayed vomiting.