European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Thiopentone, thiopentone/ketamine, and ketamine for induction of anaesthesia in caesarean section.
Seventy-five healthy patients were randomly allocated to receive thiopentone, thiopentone/ketamine or ketamine for induction of anaesthesia for elective Caesarean section. Thiopentone resulted in the most pronounced and ketamine in the smallest drop in blood pressure, while the combination induced only moderate haemodynamic changes. ⋯ The muscle tone of neonates in the thiopentone group was more reduced than in neonates in the other two groups. Infants delivered after uterine incision-to-delivery intervals exceeding 3 min more often had Apgar scores < 7 than those delivered in less than 3 min.
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Auditory continuous reaction time was studied in three treatment groups. Twenty opioid naive patients received intramuscular morphine 0.15 mg kg-1 bodyweight for premedication. Thirty-one cancer patients were treated with oral opioids, 180 mg morphine per 24 h (median). ⋯ The reaction time was measured using 152 auditory signals and summarized as 10%, 50% and 90% percentiles. Analysing reaction time distributions, the opioid naive patients showed the greatest difference to the control group in the shortest reaction times while chronic opioid users showed the greatest difference for the longest reaction times. There seems to be a qualitative difference in reaction time distribution, between opioid naive individuals treated with single dose morphine and cancer patients in long-term treatment.
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Biphasic Positive Airway Pressure (BIPAP) can be described as pressure controlled ventilation in a system allowing unrestricted spontaneous breathing at any moment of the ventilatory cycle. It can also be described as a Continuous Positive Airway Pressure (CPAP) system with a time-cycled change of the applied CPAP level. As with a pressure controlled, time-cycled mode, the duration of each phase (T(high), T(low)) as well as the corresponding pressure levels (P(high), P(low)) can be adjusted independently. ⋯ Furthermore, spontaneous breathing of the patient does not necessitate any switching of the mode of ventilation. The transition from controlled to augmented ventilation is smooth. BIPAP enables the therapist to let the patient breathe freely even under the most invasive ventilation conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Inspiratory pressure support is a mode of partial ventilatory support which can be defined as patient-initiated, pressure-targeted and patient-interrupted. Addition of pressure support to a spontaneously breathing patient results in a reduction of respiratory rate and an increase in tidal volume. It corrects arterial blood gas abnormalities resulting from rapid shallow breathing and reduces the work of breathing. ⋯ Since it is not volume-targeted, variation in delivered ventilation may occur in unstable patients or in patients with fluctuations in respiratory drive. Clinical advantages have been found using pressure support during the process of weaning from mechanical ventilation in patients with prolonged difficulty in tolerating discontinuation from mechanical ventilation. Lastly, it can be delivered via a face-mask to avoid the need for endotracheal intubation in patients with hypercapnic respiratory failure.
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Editorial Historical Article
Mechanical ventilation in acute respiratory failure.