Anaesthesia
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Comparative Study
A comparison of propofol and methohexitone as induction agents for day case isoflurane anaesthesia.
The induction and recovery characteristics of equivalent doses of propofol and methohexitone were compared in 50 patients undergoing day case isoflurane anaesthesia. Propofol induction was smoother but was associated with greater cardiorespiratory depression. Both the speed and quality of recovery were superior with propofol compared with methohexitone.
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The effects of 0.08% and 0.5% bupivacaine, given in equal volumes as the loading dose prior to continuous infusion epidural analgesia, were compared. The incidence of hypotension, as well as the height of sensory blockade, was markedly lowered by reducing the loading dose of bupivacaine. However, the efficacy of the epidural analgesia was maintained by using the same volume for the loading dose. ⋯ There were fewer calls for intervention consequent upon the reduction in adverse effects. The use of 8 ml 0.08% bupivacaine for the loading dose or for subsequent top-ups is recommended. The concept of a liquid sleeve of local anaesthetic in the epidural space is further supported.
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Two cases of severe accidental hypothermia (core temperature less than 28 degrees C) rewarmed employing the Clinitron system are described. The physiological changes during hypothermia and rewarming are discussed and the current concepts of rewarming (active external versus internal) outlined. It is suggested that severely hypothermic patients can be successfully treated by rapid external rewarming using the Clinitron heated fluidised-bead bed. This method combines the advantages of rapid rewarming, minimal physiological disturbance and is non invasive.
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Two cases of asymptomatic epiglottic cysts which presented as partial upper airway obstruction following induction of anaesthesia are described. The incidence, pathology and anaesthetic management are discussed.