Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of famotidine and ranitidine on gastric secretion in patients undergoing elective surgery.
A randomised double-blind comparison of oral famotidine and ranitidine given 2 hours before induction, on gastric secretion (volume and pH) was carried out on 93 patients undergoing elective surgery. Gastric contents were aspirated immediately after tracheal intubation. ⋯ There was no significant difference between ranitidine and famotidine in respect of the pH. The patients premedicated with famotidine and ranitidine were well protected against Mendelson's syndrome, whereas 38% of patients from the other groups remained at risk.
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Propofol infusion for sedation of patients with head injury in intensive care. A preliminary report.
Propofol was given by continuous intravenous infusion to 10 patients with severe head injuries in the intensive care unit. Heart rate, mean arterial blood pressure, intracranial pressure, cerebral perfusion pressure, pupil size and arterial carbon dioxide tension were recorded throughout the study period. A mean infusion rate of 2.88 mg/kg/hour provided satisfactory sedation, and recovery from the propofol was often rapid. Cerebral perfusion pressure was significantly increased at 24 hours.
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A two-stage propofol infusion combined with fentanyl was used to maintain anaesthesia during coronary artery surgery in patients with good ventricular function. Whole blood propofol concentrations were measured at frequent intervals; plasma protein binding was measured before, during and after cardiopulmonary bypass. An initial infusion rate of 10 mg/kg/hour provided good protection from the pressor response to sternotomy. ⋯ Induced hypothermia resulted in an increase in propofol concentration which returned rapidly to the prebypass steady state value during rewarming. The free propofol fraction increased during cardiopulmonary bypass. No patient had any recall of operative events or required inotropic support during weaning from bypass.
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A patient with previously undiagnosed Mounier-Kuhn syndrome (tracheobronchomegaly) was admitted with a head injury after a fall. The trachea was intubated with an oral tracheal tube with high-volume low-pressure cuff. The intracuff pressure was within the normal safe range recommended by the manufacturer. ⋯ The trachea was extubated on the 15th day, and it was noticed 48 hours later that the patient was developing a tracheal stenosis at the site of the previous dilatation. The stenosis was so severe that the patient underwent resection-anastomosis surgery of his stenotic tracheal segment 2 months after extubation. It may be preferable in patients with Mounier-Kuhn syndrome who require mechanical ventilation to intubate the trachea with an uncuffed tube and to pack the throat to decrease the chances of gas leak and inhalation.
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Pharmaseal continuous flushing devices were tested with regard to flow characteristics into simulated arterial and venous pressure systems. Two driving pressures were used and it was found that variation in driving pressure made a significant difference to the flow, while arterial or venous pressure made no significant difference. The flow devices had a wide variation although they were all of the same type. The fluid volume delivered was in the region of 100 ml in a 24-hour period.