European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Brachial plexus block using a new subclavian perivascular technique: the proximal cranial needle approach.
We describe the proximal cranial needle approach for brachial plexus blockade; clear surface markings and cranial direction of the needle lead to satisfactory results with a low incidence of complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Small dose midazolam or droperidol reduces the hypnotic dose of propofol at the induction of anaesthesia.
We investigated the effect of a small dose of midazolam, ketamine, droperidol or lidocaine on the propofol dose required for hypnosis during induction of general anaesthesia. These drugs were randomly administered to 100 patients about to undergo scheduled surgery. Propofol was then infused at a rate of 250 microg kg-1 min-1 and the hypnotic dose to produce hypnosis was evaluated. ⋯ Only midazolam when compared with saline administration, (176 +/- 66 s and 298 +/- 126 s, respectively), shortened the time to achieve hypnosis. The changes in blood pressure (non-invasive) and heart rate were not significantly different in all groups during the induction of anaesthesia and oro-tracheal intubation. These results raise the possibility that new combinations of central nervous system drugs, such as droperidol and propofol, have a potential to reduce the dose of intravenous anaesthetics, including propofol, that produce hypnosis without significant adverse effects.
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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.