British journal of anaesthesia
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The breakage of an epidural catheter within a patient is uncommon, but troublesome, complication of epidural block, and its cause is rarely discovered. In this case report, our aim was to present an effusion between s.c. tissue and fascia in the lumbar region because of a broken fragment of epidural catheter which was unnoticed during its removal.
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Review Randomized Controlled Trial
The effect of bi-level positive airway pressure mechanical ventilation on gas exchange during general anaesthesia.
Atelectasis may occur and ventilation-perfusion mismatch may increase during general anaesthesia with neuromuscular paralysis and mechanical ventilation, though preservation of some intermittent muscle contraction might mitigate this process. There is still no ideal manoeuvre to minimize such mismatch or atelectasis. Bi-level positive airway pressure (BiPAP) ventilation adjusts to extra breaths and improves gas exchange during recovery of diaphragm function after neuromuscular paralysis. We hypothesize that BiPAP ventilation may limit the development of pulmonary shunt and may improve ventilation-perfusion mismatch when compared with standard IPPV, with or without PEEP when neuromuscular paralysis has been used during surgery. ⋯ BiPAP ventilation was beneficial in decreasing ventilation-perfusion mismatch and improving oxygenation when compared with conventional IPPV (with or without PEEP).
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Randomized Controlled Trial
Magnesium moderately decreases remifentanil dosage required for pain management after cardiac surgery.
Magnesium is a calcium and an NMDA-receptor antagonist and can modify important mechanisms of nociception. We evaluated the co-analgesic effect of magnesium in the postoperative setting after on-pump cardiac surgery. ⋯ Magnesium gluconate moderately reduced the remifentanil consumption without serious side-effects. The opioid-sparing effect of magnesium may be greater at higher pain intensities and with increased dosages.
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The laryngeal mask airway CTrach (CTrach) is a variant of the intubating laryngeal mask airway. It provides visualization of the larynx during intubation and is designed to increase the success rates of ventilation and tracheal intubation. ⋯ In 60 patients with normal airways, the CTrach was used successfully for ventilation, with successful tracheal intubation in 59 patients. Tracheal intubation can be successful despite grade III or IV views.
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Randomized Controlled Trial
The influence of xenon on regulation of the autonomic nervous system in patients at high risk of perioperative cardiac complications.
As xenon anaesthesia (XE) does not produce haemodynamic depression its use may be of benefit in patients at high risk of intraoperative haemodynamic instability and perioperative cardiac complications. XE (n=22) was compared with total i.v. anaesthesia (TIVA, n=22) for differences in autonomic regulation, peri- and postoperative performance. ⋯ XE patients demonstrated lower sympathetic and higher parasympathetic activity as compared with TIVA patients. This was reflected by significant differences in haemodynamics but did not correlate with a better postoperative outcome. Thus, it remains controversial whether XE provides benefits in high risk patients.