European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Total intravenous anaesthesia with sufentanil-midazolam for major abdominal surgery.
Haemodynamic and endocrine stress responses were compared during total intravenous anaesthesia with sufentanil and midazolam or fentanyl and midazolam in patients undergoing elective major abdominal surgery. Twenty-two ASA I and II patients were allocated randomly to receive sufentanil (induction 1.5 micrograms kg-1 plus infusion 1.5 micrograms kg-1 h-1) or fentanyl (induction 10 micrograms kg-1 plus infusion 10 micrograms kg-1 h-1) supplemented with 0.15 microgram kg-1 sufentanil or 1 microgram kg-1 fentanyl as necessary. Midazolam was infused to obtain plasma concentrations of 500-600 ng ml-1. ⋯ Cortisol, glucose and lactate concentrations increased in both groups. Bradycardia occurred in four patients with sufentanil and in three with fentanyl. There were two cases of marked thoracic rigidity with sufentanil and one with fentanyl.
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Propofol has been reported to cause discolouration of urine and hair. A case of green discolouration of the liver is reported in a 56-year-old man after long-term sedation with propofol in the intensive care unit. After discontinuation of propofol the discolouration of the liver disappeared. This phenomenon is due to metabolism of propofol which may lead to a phenolic green chromophore which is conjugated in the liver and excreted in the urine.
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Comparative Study
Attendance of the anaesthesiologist to the patient. National recommendations for standard of anaesthetic practice.
The national recommendations for standard of anaesthetic practice in six countries of the European Community are compared with respect to the attendance of the anaesthesiologist to the patient. These standards apply to anaesthesia, major regional anaesthesia and sedation administered by anaesthesiologists. The attendance to the patient varies from strict continuous presence of the anaesthesiologist to observation of the patient by a non-medical assistant and the anaesthesiologist taking care of another anaesthetized patient. Items which all standards should mention are defined.