British journal of anaesthesia
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Witnessed resuscitation is widely accepted in paediatric practice and is becoming more common in adult emergency departments, but information on this topic is sparse. ⋯ Intensive care staff support witnessed resuscitation. Many intensive care personnel have experienced witnessed resuscitation and the majority felt that relatives gained benefit. Almost all agree that the views of both patient and relatives should be sought formally before admission to intensive care.
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A patient with acute renal failure associated with lactic acidosis as a result of concurrent treatment with metformin is described. Rofecoxib may have been a precipitating factor. The risk of renal failure with the use of traditional NSAIDs is well known. However, what is less well appreciated is the role that the COX 2 inhibitors may play in the development of renal failure which, when it occurs in a patient on metformin, can lead to a potentially disastrous outcome.
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Target-controlled infusions (TCI) are used to simplify administration and increase precision of i.v. drugs during general anaesthesia. However, there is a limited relationship between preset targets and measured concentrations of drugs and between measured concentrations and measures of brain function, such as the bispectral index (BIS). ⋯ TCI devices for remifentanil and propofol result in large variation in measured serum concentrations. The lack of correlation between BIS and serum concentrations of propofol adds to the debate about whether BIS measures hypnosis as a graded state during surgery. This study confirms that women wake up faster than men, but provides no explanation for this repeatedly shown difference.
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Comparative Study
Increased carbon dioxide absorption during retroperitoneal laparoscopy.
Retroperitoneoscopy for renal surgery is now a common procedure. We compared carbon dioxide absorption in patients undergoing retroperitoneoscopy for adrenal or renal surgery with that of patients undergoing laparoscopic cholecystectomy. ⋯ Retroperitoneal carbon dioxide insufflation causes more carbon dioxide absorption than intraperitoneal insufflation, and controlled ventilation should be increased if hypercapnia should be avoided.