British journal of anaesthesia
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We report the use of the ProSeal laryngeal mask airway to establish and maintain the airway during emergency Caesarean section when tracheal intubation had failed with conventional laryngoscopy and mask ventilation was difficult. The ProSeal laryngeal mask allowed controlled ventilation without gas leak and facilitated drainage of the stomach.
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Randomized Controlled Trial Comparative Study Clinical Trial
The Bispectral Index in children: comparing isoflurane and halothane.
The Bispectral Index (BIS) has been calibrated for several general anaesthetic agents including isoflurane. Halothane is still used in paediatric anaesthesia. Compared with other volatile anaesthetics, halothane has a different receptor affinity and differing effects on the EEG. There are limited data evaluating the BIS with halothane. We set out to compare the BIS using halothane and isoflurane at a clinically relevant equipotent concentration (1 MAC) and at a reproducible measure of anaesthetic effect (awakening). ⋯ At equipotent concentrations of halothane and isoflurane BIS valves were significantly greater with halothane. At awakening the BIS values were equivalent for each agent. This finding is consistent with the BIS being more affected by the agent used at higher concentrations of anaesthetic. The BIS must be interpreted with caution when using halothane.
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It has been suggested that obstetric epidurals lead to chronic adhesive arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over its symptomatology. ⋯ Using these criteria, there is evidence to show that epidural or subarachnoid placement of some contrast media, preservatives and possibly vasoconstrictors, may lead to CAA. No evidence was found that the preservative-free, low concentration bupivacaine with opioid mixtures or plain bupivacaine currently used in labour lead to CAA.
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Cardiac tamponade is a serious complication of central venous catheter (CVC) insertion. Current guidelines strongly advise that the CVC tip should be located in the superior vena cava (SVC) and outside the pericardial sac. This may be difficult to verify as the exact location of the pericardium cannot be seen on a normal chest x-ray. The carina is an alternative radiographic marker for correct CVC placement, suggested on the basis of studies of embalmed cadavers. ⋯ We confirm that the carina is a reliable, simple anatomical landmark that can be identified in vivo for the correct placement of CVCs outside the boundaries of the pericardial sac.