European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
The influence of the alpha2-adrenoceptor agonist, clonidine, on the EEG and on the MAC of isoflurane.
We investigated the influence of intravenous clonidine 2, 4 and 6 microg kg-1 on the electroencephalogram and on the minimal alveolar concentration of isoflurane in 40 patients aged 20-60 years undergoing elective surgery. Minimal alveolar concentration was determined using the Dixon 'up-and-down' method. Thirty min after the clonidine infusion anaesthesia was induced with etomidate, 0.25 mg kg-1. ⋯ The minimal alveolar concentration of isoflurane decreased in a dose-dependent manner from 1.32% (95% CI, 1.28%-1.36%) in the control group to 1.03% (0.9%-1.18%) in patients given clonidine 6 microg kg-1. Clonidine 4 and 6 microg kg-1 was associated with a moderate reduction in heart rate and arterial systolic blood pressure. We recommend the use of clonidine intravenously as an adjunct to general anaesthesia in a dose of 4 microg kg-1 given 15 min before induction of anaesthesia.
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Comparative Study
Reducing the demand for admission to intensive care after major abdominal surgery by a change in anaesthetic practice and the use of remifentanil.
We have used a remifentanil-based anaesthetic for patients undergoing major abdominal surgery who would normally have gone to the intensive care unit in this hospital. Avoiding intensive care unit admission was considered an advantage as a shortage of intensive care unit beds was leading to the cancellation of operations. We first used remifentanil as part of a safety and efficacy study. ⋯ The need for intensive care and therefore cancellation of surgery was reduced. In contrast, only one patient's trachea was extubated immediately after surgery in the group of patients anaesthetized before the introduction of remifentanil. A remifentanil-based technique in combination with a change in organization has therefore enabled us to avoid admission to the intensive care unit for these patients.