Subject(s)
Conscious Sedation , Dental Care , Hypnotics and Sedatives/adverse effects , Movement Disorders , Propofol/adverse effects , Aged , Female , Humans , Hypnotics and Sedatives/administration & dosage , Infusions, Intravenous , Male , Midazolam/administration & dosage , Middle Aged , Movement/drug effects , Movement Disorders/physiopathology , Propofol/administration & dosageABSTRACT
Delayed surgery has become widely accepted in the management of congenital diaphragmatic hernia after comparing outcomes only with historical retrospective controls. It was the aim of this study to compare early and delayed hernia repair in a randomized prospective clinical trial. Fifty-four infants were randomized to receive either early repair (within 4 hours of admission) or delayed repair (more than 24 hours after birth). The survival rate was higher for the delayed group (57% v 46%), but the difference was not significant (difference: -11; 95% confidence limits: -37.5, 15.5). There were no significant differences between the two groups with respect to length of hospital stay, ventilator dependency, or survival time. Recorded preoperative risk factors were similar for the two groups. Eight infants in the delayed repair group died without having undergone surgery. The optimum time for surgery still needs clarification.
Subject(s)
Hernia, Diaphragmatic/surgery , Hernias, Diaphragmatic, Congenital , Blood Gas Analysis , England/epidemiology , Hernia, Diaphragmatic/blood , Hernia, Diaphragmatic/complications , Hernia, Diaphragmatic/mortality , Hernia, Diaphragmatic/pathology , Humans , Infant, Newborn , Length of Stay , Lung/abnormalities , Prospective Studies , Respiration, Artificial , Survival Rate , Time FactorsABSTRACT
Tolerance to the sedative effects of the benzodiazepine group of drugs is well documented. A brief review of the literature is presented. Three cases in which tolerance to intravenous midazolam became apparent and caused a significant problem during the attempted induction of conscious sedation are described. The patients were all concurrently receiving treatment with other benzodiazepines. It is recommended that patients with a history of regular, current benzodiazepine use be treated with caution with regard to this type of sedation.
Subject(s)
Anesthesia, Dental/methods , Benzodiazepines/adverse effects , Conscious Sedation/methods , Midazolam/therapeutic use , Adult , Benzodiazepines/pharmacokinetics , Benzodiazepines/therapeutic use , Drug Tolerance , Female , Humans , Male , Midazolam/administration & dosage , Middle AgedABSTRACT
A twin-tube breathing system for inhalational anaesthesia in dental surgery is described. The system is a modification of a parallel Mapleson 'A' breathing system and is suitable for use with continuous flow anaesthetic machines. Resistance to airflow has been evaluated and is within the recommended ranges at all flows likely to be experienced in normal clinical conditions. The system is suitable for children and adults, easy to use and efficient. The expiratory valve is located remote from the face and the system is suitable for scavenging by active, assisted or passive systems.
Subject(s)
Anesthesia, Dental/instrumentation , Anesthesia, Inhalation/instrumentation , Respiration/physiology , Adolescent , Adult , Carbon Dioxide/physiology , Child , Child, Preschool , Equipment Design , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Pressure , Respiratory Mechanics/physiologySubject(s)
Hospital Records , Information Systems , Libraries, Medical , Medical Records , MinnesotaABSTRACT
The incidence of postoperative bronchopneumonia in 70 patients undergoing upper abdominal surgery who received intramuscular and oral bromhexine after operation for 5 days was 25% (8 of 32), compared with 34% (13 of 38) in a control group, but this difference in favour of bromhexine does not reach statistical significance. All patients had postoperative physiotherapy. However, in a high-risk group (patients who smoked more than 10 cigarettes a day, who admitted to a productive cough before the operation and in whom the forced expiratory volume as a percentage of the forced vital capacity was less than 70) the incidence of postoperative bronchopneumonia in those who had bromhexine was 6 of 17 compared with 9 of 15 in the controls. Thus bromhexine for the prevention and treatment of postoperative bronchopneumonia in high-risk patients after upper abdominal surgery deserves further study.
