British journal of anaesthesia
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Case Reports
Management of tracheomalacia in association with congenital tracheo-oesophageal fistula.
Tracheomalacia is commonly associated with oesophageal atresia and tracheo-oesophageal fistula. Severe cases may present with life threatening cyanotic and apnoeic attacks following surgical repair of the oesophageal atresia. The anaesthetic, and surgical management (by tracheopexy), of such a case are described.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of "priming" on the potency of non-depolarizing neuromuscular blocking agents.
Dose-response curves have been constructed to determine the ED50 and ED95 (doses required to produce a 50% and a 95% block, respectively) following administration of a small "priming" dose of atracurium 50 micrograms kg-1, vecuronium 10 micrograms kg-1 or pancuronium 10 micrograms kg-1. The myoneural blockers were administered subsequently as a single bolus. ⋯ The values showed no significant differences between the respective primed and control groups. Contrary to previous suggestions, our results show no enhancement of blockade when these drugs were administered in divided doses.
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High frequency jet ventilation (HFJV) experiments were performed in healthy anaesthetized mongrel dogs via a multilumen tracheal jet tube to examine the influence of gas flow, ventilatory frequency and inspiration time (as a percentage of the total ventilatory cycle) on gas exchange. We compared arterial PO2, PCO2 and cardiac output during periods of adequate intermittent positive pressure ventilation (IPPV) and periods of HFJV. ⋯ Inspiration time proved to be important in determining efficacy of ventilation for a fixed ventilator minute volume. Cardiac output during all HFJV settings was equal to or greater than cardiac output during IPPV, even as those HFJV settings that resulted in a positive end-expiratory pressure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly.
In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). ⋯ A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.