British journal of anaesthesia
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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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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized study comparing the effects of hydroxyethyl starch solution with Gelofusine on pulmonary function in patients undergoing abdominal aortic aneurysm surgery.
Restoring blood flow to ischaemic tissue can cause lung damage with pulmonary oedema. Hydroxyethyl starch (HES) solution, when used for volume replacement, may modify and reduce the degree of ischaemia-reperfusion injury. We compared the effects of HES solution with those of Gelofusine solution on pulmonary function, microvascular permeability and neutrophil activation in patients undergoing elective infrarenal abdominal aortic aneurysm surgery. ⋯ Compared with Gelofusine, the perioperative pulmonary function of patients treated with HES after abdominal aortic aneurysm surgery was better.
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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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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.
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Fluid depletion during the perioperative period is associated with poorer outcome. Non-invasive measurement of total body water by bioimpedance may enable preoperative fluid depletion and its influence on perioperative outcome to be assessed. ⋯ Further work is warranted to determine if bioimpedance changes may serve as a useful indicator of perioperative fluid depletion.