British journal of anaesthesia
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Comparative Study
Estimation of errors in determining intrathoracic blood volume using thermal dilution in pigs with acute lung injury and haemorrhage.
Global end diastolic volume (GEDV) has a constant and predictable relationship to intrathoracic blood volume (ITBV). The present study assesses the difference between ITBV derived from GEDV and ITBV measured directly in pigs with acute lung injury (ALI) and mild haemorrhage. ⋯ ITBV estimated by thermodilution alone is comparable to measurements made by the thermo-dye dilution technique in the presence of pulmonary hypertension and mild deficits in total blood volume.
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A 72-yr-old patient was to undergo a left lumbar plexus block by the posterior approach to achieve postoperative analgesia after hip replacement. The block failed after three unsuccessful attempts to identify nerve structures and a fascia iliaca compartment block was performed. ⋯ She was re-admitted 2 weeks after surgery because of a lower limb motor deficit and a left retroperitoneal haematoma requiring blood transfusion. Clinicians need to be aware of this potential complication of lumbar plexus block in patients receiving thrombphylaxis.
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Case Reports
High-frequency oscillatory ventilation and an interventional lung assist device to treat hypoxaemia and hypercapnia.
A male patient accidentally aspirated paraffin oil when performing as a fire-eater. Severe acute respiratory distress syndrome (Pa(o(2))/Fi(o(2)) ratio 10.7 kPa) developed within 24 h. Conventional pressure-controlled ventilation (PCV) with high airway pressures and low tidal volumes failed to improve oxygenation. ⋯ Pa(co(2)) normalized after initiation of ILA. HFOV with a mean airway pressure of 32 cm H(2)O was maintained, but with a higher oscillatory frequency (9 Hz) and very low oscillatory amplitude (25 cm H(2)O). After 6 days, the patient was transferred to a conventional ventilator, and ILA was discontinued after 13 days without complications.
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Pharmacokinetic and/or pharmacodynamic changes, which may occur with increasing age, could alter the clinical profile of the new local anaesthetic levobupivacaine. We investigated the effect of age on the absorption and disposition kinetics and the neural block characteristics after epidural administration of levobupivacaine 0.75%. ⋯ Age influences the pharmacokinetics, in particular the early absorption kinetics, and the neural block characteristics after epidural administration of levobupivacaine. Changes in the upper level of analgesia are best explained by anatomical considerations and possibly pharmacodynamic changes in the elderly.