British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Activation of electrocorticographic activity with remifentanil and alfentanil during neurosurgical excision of epileptogenic focus.
Opioids are known to stimulate surface electroencephalographic activity in patients with temporal lobe epilepsy. The objective of the current study was to compare the electrocorticographic activation effects of the newer short-acting opioid remifentanil with those of alfentanil during epilepsy surgery under general anaesthesia. ⋯ We conclude that at the doses used in this study, alfentanil is the better opioid for intraoperative activation of the ECoG in neurosurgical patients undergoing resection of a temporal lobe epileptic focus. This pharmacological activation of epileptiform activity assists in localizing and confirming the site of surgical excision. Neither alfentanil nor remifentanil activated epileptiform activity in non-epileptic brain tissue.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized crossover comparison of the ProSeal laryngeal mask airway with the Laryngeal Tube during anaesthesia with controlled ventilation.
The Laryngeal Tube (LT) performs similarly to the classic laryngeal mask airway during controlled ventilation but with an improved airway seal. We compared the laryngeal tube with the ProSeal laryngeal mask airway (PLMA) throughout anaesthesia. ⋯ The two devices performed equally well in terms of seal pressure. The PLMA was quicker to insert. Efficacy of ventilation was significantly better with the PLMA than the LT. The PLMA allowed a significantly better view of the larynx with a fibre-optic laryngoscope, and may therefore be of more use in cases where visualization of the larynx is required.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized comparison of the classic Laryngeal Mask Airway with the Airway Management Device during anaesthesia.
We compared the modified Airway Management Device (AMD) with the classic Laryngeal Mask Airway (cLMA) in a randomized comparative trial. ⋯ Successful insertion of the cLMA is more likely than that of the AMD. Insertion of the AMD required more attempts and caused a greater number of complications. Fibre-optic position was poorer than with the cLMA. When an airway is established, the AMD caused a greater number of complications during anaesthesia and failed more frequently than the cLMA. During recovery from anaesthesia, more complications occurred with the AMD. Overall performance of the AMD was poorer than with the classic LMA.
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We describe a patient at 20-22 weeks gestation, with a known difficult airway, who underwent eight sessions of electroconvulsive therapy using the ProSeal laryngeal mask airway and controlled ventilation. The airway management options for brief periods of general anaesthesia in patients with increased gastric volume are discussed.
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This study was undertaken to investigate why the superficial cervical plexus block for carotid endarterectomy is so effective. Initial consideration would suggest that a superficial injection would be unlikely to block all terminal fibres of relevant nerves. One possibility is that the local anaesthetic crosses the deep cervical fascia and blocks the cervical nerves at their roots. ⋯ The superficial cervical space communicates with the deep cervical space and this may explain the efficacy of the superficial block. The method of communication remains unknown. Our findings also indicate that the suitable site of injection for the superficial cervical plexus block is below the investing fascia of the neck, and not just subcutaneous.