British journal of anaesthesia
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Clinical temperature management remains challenging. Choosing the right sensor location to determine the core body temperature is a particular matter of academic and clinical debate. This study aimed to investigate the relationship of measured temperatures at different sites during surgery in deep hypothermic patients. ⋯ We suggest that measured surrogate temperatures as indices of the cerebral temperature (e.g. vesical bladder temperature) should be interpreted with respect to the temporal and spatial dispersion during cooling and rewarming phases.
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We tested the ability of mean acceleration (Acc) and peak velocity (V peak) of the aortic velocity signal measured by oesophageal Doppler to reflect left ventricular (LV) systolic performance. ⋯ V peak and, to a lesser extent, Acc measured by oesophageal Doppler behaved as markers of LV systolic performance as they were almost insensitive to fluid administration and changed to a much larger extent with dobutamine. These indices could be used to estimate LV systolic performance and to assess the effects of inotropic therapy.
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We report on a case in which computed tomography was used to guide placement of an epidural catheter in a patient with severe scoliosis and congenital dwarfism. In addition, the computed tomograms were corroborated with ultrasound and fluoroscopic images in the patient. Three years later, the patient had a spinal anaesthetic performed with only the use of ultrasound-guidance. ⋯ Moderate idiopathic scoliosis is managed with a paramedian approach on the convex-side of the curve or a midline approach with angulation towards the convex-side or with the aid of imaging such as ultrasound. Severe idiopathic scoliosis is managed with the assistance of imaging or an alternative form of pain management should be considered. A systematic approach may facilitate safe, efficient, and successful neuraxial anaesthesia procedures in the scoliotic patient.
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Letter Case Reports
Quadriplegia after interscalene block for shoulder surgery in sitting position.