Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Fentanyl and the metabolic response to gastric surgery.
The effect of the supplementation of nitrous oxide-oxygen anaesthesia with either 50 micrograms fentanyl/kg body weight or 0.5-1.0% halothane on the metabolic and hormonal response to gastric surgery was investigated in 16 patients. Those patients who received fentanyl showed a significant decrease (p less than 0.05) in the hyperglycemic response to surgery after 30 and 90 minutes and a significant decrease (p less than 0.05) in the plasma cortisol response after 30 minutes. ⋯ This required the intravenous administration of naloxone and careful supervision in the early postoperative period. It is concluded that the transient metabolic and endocrine benefits produced by fentanyl do not compensate for the severe respiratory problems postoperatively and thus 'high-dose fentanyl' cannot be recommended for upper abdominal surgery.
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The effects of precurarisation, with small doses of pancuronium, curare or gallamine, on the neuromuscular blockade following suxamethonium, 1 mg/kg, were studied using train-of-four stimulation. The duration of the block was reduced by pretreatment with d-tubocurarine and gallamine but increased with pancuronium. The degree of competitive neuromuscular blockade, both after administration of the precurarising dose and at full recovery from suxamethonium was mild and was insufficient to be a cause of postoperative muscle weakness.
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Comparative Study
The oesophageal obturator airway: A study of cadaver lund ventilation through obturator airways and tracheal tubes.
Ventilation of cadaver lungs using a Pneupac ventilator through oesophageal obturator airways (EOA), oesophageal gastric tube airways (EGTA), and tracheal tubes was studied in 23 subjects. The mean tidal volume obtained through tracheal tubes was 381 ml compared with a mean tidal volume of 156 ml obtained through the EOA and a mean tidal volume of 237 ml through the EGTA. ⋯ This represents adequate ventilation in these very stiff lungs. Subject to modification of the device and prevention of leakage the oesophageal gastric tube airway is a useful alternative to tracheal intubation in certain adverse conditions.