Subject(s)
Methadone/poisoning , Adult , Drug Overdose , Fatal Outcome , Humans , Male , Naloxone/therapeutic useABSTRACT
We have compared changes in haemodynamic variables before and during transurethral resection of the prostate in 22 patients under general or spinal anaesthesia. In the general anaesthetic group there was a significant decrease in cardiac output (mean 32% (SEM 5%)) and mean arterial pressure (14% (3%)) after induction of anaesthesia and a significant decrease (27% (3%)) in heart rate before the start of resection. Otherwise, variables remained close to baseline values. In the subarachnoid block group, mean arterial pressure decreased after induction (16% (2%)), but overall variables remained unchanged. We conclude that with both these anaesthetic techniques the greatest changes in haemodynamic variables occurred shortly after induction, and that these changes were greater during general than spinal anaesthesia. The resection period was not associated with significant haemodynamic changes.
Subject(s)
Anesthesia, General , Anesthesia, Spinal , Hemodynamics/physiology , Prostatectomy , Aged , Aged, 80 and over , Blood Pressure/physiology , Cardiac Output/physiology , Heart Rate/physiology , Humans , Male , Middle Aged , Random Allocation , Time Factors , Vascular Resistance/physiologyABSTRACT
High continuous flow breathing systems are now available to provide fresh gas flows well in excess of 100 l.min-1 in continuous positive airway pressure systems used for respiratory support. The performance of two commonly used intensive care humidifiers, the Kendal Conchatherm and the Fisher and Paykel FP310 have been assessed at flows of 50, 75, 100, 125 and 150 l.min-1. Their performance when using two humidifiers connected in parallel and in series was also studied. At a fresh gas flow of 100 l.min-1 the single Conchatherm gave an absolute water vapour concentration of 15.6 g.m-3 and the single FP310 11.9 g.m-3. At all flows the best results were achieved using two Conchaterm humidifiers in series. It is concluded that with high continuous flow breathing systems the humidification achieved with conventional humidifiers may be inadequate and it may be necessary to combine two humidifiers to obtain clinically useful humidification.
Subject(s)
Critical Care , Humidity , Positive-Pressure Respiration/instrumentation , Humans , Time Factors , WaterSubject(s)
Anesthesia, Spinal/adverse effects , Heart Arrest/etiology , Prostatectomy , Aged , Aged, 80 and over , Bupivacaine , Humans , Male , Time FactorsSubject(s)
Anesthesia, General , Hemodynamics , Prostatectomy , Humans , Male , Prostatectomy/adverse effects , Stress, Physiological/etiologyABSTRACT
Fifty patients with fractured neck of femur that required surgical correction with either a compression screw or pin and plate device were randomly allocated to receive one of two anaesthetic techniques, general anaesthesia combined with either opioid supplementation or triple nerve block (three in one block) with subcostal nerve block. The nerve blocks significantly reduced the quantity of opioid administered after operation; 48% of these patients required no additional analgesia in the first 24 hours. Plasma prilocaine levels in these patients were well below the toxic threshold, and peak absorption occurred 20 minutes after the injection. No untoward sequelae were associated with the nerve blocks.
Subject(s)
Femoral Neck Fractures/surgery , Fracture Fixation, Internal , Nerve Block , Pain, Postoperative/prevention & control , Prilocaine , Aged , Aged, 80 and over , Animals , Female , Femoral Neck Fractures/epidemiology , Femoral Nerve , Humans , Male , Middle Aged , Obturator Nerve , Prospective Studies , Skin/innervation , Thigh/innervationABSTRACT
Oxygenated crystalloid cardioplegia was found not to produce better cardioprotection than blood or crystalloid cardioplegia, as assessed by myoglobin and creatine kinase MB (CPK-MB) isoenzyme, in patients undergoing coronary artery surgery. Myoglobin and CPK-MB levels were found to peak at 1 and 3 h, respectively, following release of the aortic cross-clamp. There was a good correlation between peak myoglobin and CPK-MB levels. CPK-MB of non-cardiac origin was found to represent a substantial proportion of total CPK-MB 4 h after the release of the aortic cross-clamp.
Subject(s)
Cardioplegic Solutions/pharmacology , Coronary Artery Bypass , Creatine Kinase/metabolism , Myocardium/metabolism , Myoglobin/metabolism , Potassium Compounds , Blood , Humans , Isoenzymes , Myocardial Reperfusion , Oxygen/pharmacology , Postoperative Period , Potassium/pharmacology , Prospective StudiesABSTRACT
The dimensions of currently available spinal needles (0.7 mm (22-gauge) to 0.45 mm (26-gauge) external diameter) were measured and compared with the International Standard (ISO 7864-1984 E). The in vitro performance of the needles was assessed by comparing times to appearance of cerebrospinal fluid and flow rates through the needles. There were wide variations in the measurements and performance of the different needles.
Subject(s)
Cerebrospinal Fluid/physiology , Injections, Spinal/instrumentation , Needles/standards , Humans , In Vitro Techniques , Reference Standards , RheologySubject(s)
Epiglottitis/diagnosis , Laryngitis/diagnosis , Adolescent , Adult , Emergencies , Epiglottitis/therapy , Humans , Intubation, Intratracheal , Male , Middle AgedABSTRACT
EMLA cream (eutectic mixture of local anaesthetics) was tested in a double-blind clinical trial to examine its effect on the pain of venepuncture at induction of anaesthesia in 40 children (aged 3-13 yrs). Four pain-assessment methods were used and an assessment of the technical ease of venepuncture was made. EMLA was found to reduce significantly the pain and technical difficulty of venepuncture. This study confirms that EMLA is an effective method of reducing the pain and technical difficulty of paediatric venepuncture using 25-gauge needles for induction of anaesthesia in children.
