European journal of anaesthesiology
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Case Reports
Catecholamine-resistant cardiovascular collapse after propofol, atracurium and gentamicin.
A 43-year-old male received intravenous propofol, atracurium and gentamicin and experienced cardiovascular collapse with the features of an acute drug reaction. Prolonged cardiopulmonary resuscitation with fluids and large amounts of adrenaline and noradrenaline led to full recovery without neurological deficit. No biochemical abnormality was detected.
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The haemodynamic effects of anaesthesia with gamma-hydroxybutyrate (GHB)/sufentanil for elective coronary artery bypass grafting (CABG) were investigated and compared in patients with unimpaired left ventricular function (ejection fraction > or = 45%, left ventricular end diastolic pressure < or = 16 mmHg) and patients with impaired left ventricular function. In 38 consecutive patients scheduled for CABG (21 with unimpaired and 17 with impaired left ventricular function), anaesthesia was induced with etomidate, sufentanil and pancuronium. After tracheal intubation, the lungs were normoventilated (end tidal Pco2 4.9-5.6 kPa) with an oxygen-air mixture (Fio2 0.5). ⋯ A total of 14 out of 21 patients (67%) with unimpaired and 10 out of 17 patients (59%) with impaired ventricular function required supplementary administration of opioids to control temporary hypertension after sternotomy. No episodes of myocardial ischaemia were detected during the study period using ST segment analysis (leads II and V5). The results of this study suggest that GHB provides adequate haemodynamic conditions in the prebypass period and may be a suitable agent for TIVA also in patients with impaired left ventricular function undergoing CABG.
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Editorial Historical Article
150 years of anaesthesia--a long way to perioperative medicine: the modern role of the anaesthesiologist.
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Letter Case Reports
Masseter spasm during induction of anaesthesia using propofol and fentanyl.