Chest physiotherapy using a manual ventilation technique was carried out on 9 intubated patients. One patient was studied on two occasions. The maximum expiratory flow rate (MEFR) was recorded during: (A) manual ventilation without physiotherapy, (B) manual ventilation with chest compression, (C) manual ventilation and chest compression, after application of the abdominal binder. Statistical analysis was carried out to allow for differences in tidal volume (Vt). Chest physiotherapy increased the mean MEFR and application of an abdominal binder (together with physiotherapy) caused a further increase in MEFR. The mean MEFR (assuming a common Vt of 1360 ml) in each group was; (A) = 73.3 l min-1, (B) = 103.9 l min-1, (C) = 113.93 l min-1.
Although a number of specific techniques have been described, injection of local anaesthetic to the brachial plexus is performed essentially in three areas: between the scalene muscles, over the first rib, and in the axilla. Injection at each of these points produces blocks which vary in distribution, but every technique requires a relatively large dose of local anaesthetic. Thus knowledge of the systemic drug concentrations which are likely to result is essential.Most previous work has considered the effects of using one drug for one particular technique. Where comparisons can be made with the results of a study in which a number of drugs were injected by the inter scalene technique, there is a suggestion that this method results in higher systemic concentrations than others [1]. Therefore, a study was devised to allow comparison of the systemic concentrations produced by three different techniques of brachial plexus blockade. PATIENTS AND METHODSPatients (ASA I-III) who were to undergo hand or wrist operations under brachial plexus blockade gave informed consent for the study. After an overnight fast and premedication with diazepam 10 mg by mouth, the patient was transferred to the operating theatre and a cannula placed in a vein in the contralateral antecubital fossa for blood sampling. A control sample (time 0) was taken.Patients were allocated to receive 15% plain prilocaine 35 ml by the interscalene, subclavian perivascular, or axillary techniques [2]. The interscalene route was not used in those patients undergoing surgery predominantly of the ulnar side of the hand. Blood samples were taken into lithium-heparin tubes at 5, 10, 15, 20, 25, 30, 45 and 60 min after the end of the injection and were centrifuged and die plasma withdrawn and frozen in plain tubes pending subsequent analysis. Prilocaine concentrations were measured by high performance liquid chromatography (HPLC). Thirty minutes after the injection, supplementary nerve blocks using lignocaine were performed, as necessary; i.v. sedation was given if needed, and surgery commenced. Measurement of prilocaine concentration (HPLC)Plasma 0.25 ml, internal standard solution (ethylmethylglycinexylidide) 50 ulitre, 100 ng ml-1 , NaOH 200 ulitre, il mol litre" 1 and diethylether 5 ml were vortexed (1 min), centrifuged (5 min, 3000 rev min~l) and the ether layer transferred to a conical tube. After evaporation to dryness at 35 °C, the residue was reconstituted in 200 ulitre of mobile phase (12:88 acetonitrile/ water plus triethylamine/orthophosphric acid to pH 3.0) and injected to a Novopac column within a Z-module (Waters Ltd) and widi a C-18 GuardDownloaded from https://academic.oup.
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