Anaesthesia
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Review
General kinetic and dynamic principles and their application to continuous infusion anaesthesia.
The use of intravenous anaesthetic agents by continuous infusion requires knowledge of their pharmacokinetic properties. In this article, the general pharmacokinetic principles behind the use of infusions of intravenous agents are presented and the literature with regard to the individual drugs used in this way is reviewed.
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In six patients undergoing gynaecological surgery computer assisted total intravenous anaesthesia (CATIA) was performed using etomidate and alfentanil. Constant plasma levels of etomidate (0.3 microgram/ml) from the very beginning onwards were achieved using the so called B. ⋯ Alfentanil plasma concentrations of 0.45 microgram/ml were maintained by the same infusion scheme beginning with skin incision until 20 minutes prior to the end of surgery. The proposed concept of CATIA provided an adequate analgesic and hypnotic effect during anaesthesia for abdominal surgery with a recovery period of short duration.
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Randomized Controlled Trial Clinical Trial
Cardiovascular response to intubation. A comparative study of thiopentone and midazolam.
The cardiovascular response evoked by tracheal intubation was observed in 20 patients undergoing elective abdominal surgery in whom anaesthesia was induced with either midazolam 0.3 mg/kg or thiopentone 4.5 mg/kg followed by pancuronium 0.1 mg/kg. In the thiopentone group, intubation caused a mean rise in systolic arterial pressure from 141 to 193 mmHg (p less than 0.0005) and in the heart rate-systolic pressure product from 11101 to 21763 (p less than 0.05); 5 minutes later the mean values were still 173 mmHg and 19030 respectively. In the midazolam group systolic arterial pressure and the rate pressure product increased from 138 to 151 mmHg and 10960 to 14267 respectively in response to intubation. These values were significantly lower than the thiopentone group (p less than 0.005 in each case) and were relatively transient and returned to control values within 5 minutes.
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Etomidate has been studied in two groups of patients. In Group 1, 50 patients received etomidate 100 micrograms/kg/minute with fentanyl and a muscle relaxant, ventilation being with air and oxygen (50%). The technique gave a smooth, pleasant induction with all patients asleep within 2 minutes. ⋯ The cardiovascular system remained stable in all patients. Mean recovery time was 16.1 minutes (range 3-38 minutes). Twitching and restlessness were the main complications during recovery.
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Biography Historical Article
Nitrous oxide in Bristol in 1836. A series of lectures by William Herapath (1796-1868).