British journal of anaesthesia
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Comparative Study
Laboratory evaluation of low-pressure tracheal tube cuffs: large-volume v. low-volume.
Large- and low-volume low-pressure tracheal tube cuffs were compared during exposure to nitrous oxide. The compliance of both types of cuff when measured inside and outside an artificial rigid trachea, the volume of intubated cuff, the residual volume, the nitrous oxide diffusion time, and the specific diffusion rate of the cuff membrane to nitrous oxide were measured in the laboratory. From these variables, the diffusion rate of nitrous oxide, the surface area available for nitrous oxide diffusion, the tracheal wall pressure exerted by cuff, and the degree of folding of the intubated cuff were derived. The results showed that the rapid increase in pressure of the large-volume cuff when intubated was caused by low compliance, the large surface area available for nitrous oxide diffusion, and the considerable permeability of the cuff membrane to nitrous oxide.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ICI 35868, etomidate and methohexitone for day-case anaesthesia.
The anaesthetic properties and side-effects of propofol 1.5 mg kg-1, etomidate 0.2 mg kg-1, and methohexitone 1.5 mg kg-1 were compared in 71 healthy female patients undergoing short gynaecological procedures. Propofol proved to be a safe and effective agent for induction and maintenance of anaesthesia and was associated with a lower incidence of side-effects than either etomidate or methohexitone.
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Vecuronium bromide 70 micrograms kg-1 was used to facilitate tracheal intubation and provide neuromuscular blockade in 52 patients undergoing laparoscopic sterilization. Anaesthesia was maintained with 67% nitrous oxide in oxygen. Patients were monitored clinically and by tactile assessment of the evoked response of the adductor pollicis to a supramaximal train-of-four stimulation. ⋯ Residual neuromuscular blockade was antagonized rapidly at completion of surgery by neostigmine 2.5 mg i.v., which was administered provided there was at least one twitch response. The mean duration of the procedure was 14.3 min (SD 2.5 min). The mean time from injection of neostigmine to satisfactory spontaneous breathing and neuromuscular recovery was 1.6 min (SD 0.7 min).
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Paediatric anaesthesia is made easier and safer by use of the correct equipment. The widening range and increasing complexity of available apparatus makes it essential for the anaesthetist to judge which items are most useful in any individual case. As a general rule, the simplest pieces of equipment are the most reliable and among the most useful.