Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 1982
Randomized Controlled Trial Clinical TrialModerate hypotensive anaesthesia for reduction of blood loss during total hip replacement.
Thirty-two consecutive patients scheduled for total hip replacement were randomly allocated to receive either neurolept anaesthesia or halothane anaesthesia. In the halothane group, systolic blood pressure was reduced to 10.69-13.33 kPa in normotensive patients, and to 13.33-16.0 kPa in hypertensive patients by adjusting the inspired halothane concentration and using supplementary fentanyl when necessary. ⋯ The average peroperative blood loss in the halothane group was 809 ml (range 250-1700 ml); this was significantly lower than in the neurolept anaesthesia group in which an average blood loss of 1909 ml (range 600-4900 ml) occurred. Moderate hypotensive halothane anaesthesia is recommended as an anaesthetic technique for total hip replacement.
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Acta Anaesthesiol Scand · Aug 1982
Nitroprusside-hypotension: cerebral blood flow and cerebral oxygen consumption in neurosurgical patients.
The effects of nitroprusside-induced hypotension on cerebral blood flow and cerebral oxygen consumption were investigated in nine patients scheduled for cerebral arterial aneurysm surgery. Anesthesia was maintained with nitrous oxide/oxygen and fentanyl; muscle relaxation was achieved with pancuronium; PaCO2 was maintained at 4.79-5.32 kPa. Mean arterial pressure was reduced to 50 mmHg by nitroprusside infusion after opening of the dura. ⋯ Cerebral blood flow remained virtually at preinfusion values upon cessation of infusion (53 +/- 6 ml/min . 100 g). Cerebral oxygen uptake averaged 3 +/- 0.2 ml/min . 100 g before hypotension and did not change significantly during hypotension (3.3 +/- 0.3 ml/min . 100 g) and after termination of hypotension (2.7 +/- -0.3 ml/min . 100 g). In two patients nitroprusside produced a 17 and 20% increase, respectively, in cerebral blood flow with no change in cerebral oxygen consumption, together with a marked increase in cardiac output and heart rate.
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Acta Anaesthesiol Scand · Jun 1982
Randomized Controlled Trial Clinical TrialAttenuation of the circulatory response to laryngoscopy and intubation by fentanyl.
The effects of fentanyl on arterial pressure and heart rate increases during laryngoscopy and intubation were studied in 45 normotensive, surgical patients, who were randomly allocated to three groups receiving 2 or 6 micrograms/kg of fentanyl or saline in a double-blind fashion before anaesthetic induction with thiopental. Fentanyl supplementation with 2 micrograms/kg significantly attenuated the arterial pressure and heart rate increases during laryngoscopy and intubation, and fentanyl, 6 micrograms/kg, completely abolished these responses. Moreover, fentanyl given during the induction decreased the amount of fentanyl needed during the operation. Respiratory depression was not observed during recovery.
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The intellectual and technological roots of respirators and respiratory care may be traced back hundreds of years. The clinical evolution has taken the better part of a century, and it has been most closely linked to the development of open-chest surgery. Resuscitation and the treatment of poliomyelitis also have contributed ideas and technology to this evolution. ⋯ Open-chest surgery forced the change from single-agent deep anesthesia with spontaneous ventilation to a balanced technique, using multiple drugs or agents, with controlled ventilation. Open-chest surgery also necessitated that physicians specialize in anesthesiology. Scandinavian scientists and physicians have contributed greatly to the field of respirators and respiratory care, as has the specialty of anesthesiology.