Isolated forearm technique.
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Biomedical subjects
Publications and source records attributed to I F Russell.
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Thirty-five women scheduled for elective Caesarean section were randomly assigned to have subarachnoid analgesia induced in either the right or left lateral position. They were then turned supine with a wedge under the right hip. No patient in the right-sided group required further analgesia. Five patients in the left-sided group required postural manipulation to encourage the spread of analgesia and two required supplementary analgesia (P less than 0.01).
Equal volumes (2.5 ml, 12.5 mg) of plain 0.5% bupivacaine (glucose-free) and hyperbaric 0.5% bupivacaine (in 8% glucose) were compared in a randomized double-blind study of 40 patients undergoing Caesarean section under subarachnoid anaesthesia. There were no differences in the rate of onset, maximum spread, number of patients with high cervical levels, duration of anaesthesia or incidence of post-spinal headaches between the two solutions. The median maximum cephalad levels of analgesia were (hyperbaric) T1 (range C1-T4), and (plain) T2 (range C1-T4). Thirteen patients in the hyperbaric group and 10 in the isobaric group required i.v. ephedrine to treat hypotension. Nine patients (23%) developed a post-spinal headache, and three were treated with an extradural blood patch.
Fifty-five patients were assigned randomly to receive either a total i.v. anaesthetic based on a two-stage infusion of etomidate plus increments of fentanyl or a regimen based on inhaled nitrous oxide with i.v. fentanyl increments. Using the isolated forearm technique, 44% of the nitrous oxide group were found to be wakeful at some time during surgery, whereas only 7% of the etomidate group were wakeful. There was one case of awareness in the nitrous oxide group.
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Twenty-five patients had subarachnoid anaesthesia induced with 3.0 ml 0.5% bupivacaine plain. A study of the spread of analgesia demonstrated a small (2-3 segments) but significant (p less than 0.001) rise in analgesic levels when the patients were turned from a lateral to the supine position, and from the supine to prone positions.
The theoretically desirable characteristics of fluidic timing devices for use in automatic ventilators are discussed. The principal limitation of most timers described is the separate control of inspiratory and expiratory time. It is more convenient to have one control for frequency and a separate control for I:E ratio. Two new circuits are described which allow this independent adjustment of frequency and I:E ratio.
Subarachnoid anaesthesia was induced with 0.5% bupivacaine 2-3.5 ml in 33 women scheduled for elective Caesarean section. Three patients failed to develop adequate analgesia with bupivacaine but were managed satisfactorily with heavy cinchocaine. All the other patients developed adequate analgesia eventually. Since the spread of analgesia was uniquely dependent on posture a new hypothesis is presented to explain the distribution of intrathecal anaesthetic drugs in late pregnancy.
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Closing volume and other principal lung volumes were measured during and after pregnancy in 10 healthy non-smoking women aged 18--25 yr. There were no significant changes on closing volume or closing capacity. A decrease in functional residual capacity as pregnancy progressed resulted in airway closure during tidal breathing in more than 50% of subjects at term when in a supine position, but this did not occur when they were seated.
Ketamine did not provide adequate anaesthesia for pneumoencephalography in a 10-week-old child with agenesis of the corpus collosum. Associated neurological defects are the most likely reason for this failure.