Anaesthesia
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Randomized Controlled Trial Clinical Trial
Thoracic epidural analgesia started after cardiopulmonary bypass. Adrenergic, cardiovascular and respiratory sequelae.
The effects of thoracic epidural analgesia started after cardiopulmonary bypass were studied on the subsequent adrenergic, cardiovascular and respiratory responses. Sixteen cardiac surgical patients received either a standardised general anaesthetic (control group) or a standardised general anaesthetic and thoracic epidural analgesia (epidural group). The epidural catheter was sited before surgery and heparinisation. ⋯ Postoperative respiratory function was less impaired in the epidural group, with higher forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow (p < 0.05). Pain scores were also significantly lower in the epidural group (p < 0.05). There were no significant differences in cardiovascular parameters.
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The outcome of patients admitted to intensive care after a cardiac arrest was determined by reviewing intensive care unit records at four hospitals for 1993 and 1994. Of the 112 patients identified, 49 survived intensive care of whom 28 were discharged from hospital. In January 1996, 26 of the 28 patients could be traced; 22 of these were still alive. ⋯ In intensive care the factors were the presence of reactive pupils (p < 0.01), Glasgow Coma Score (p < 0.001), APACHE II score (p < 0.05), arterial standard bicarbonate (p < 0.05) and the use of inotropes (p < 0.05). It was not possible to use individual variables to predict outcome at the time of intensive care unit admission. The results suggest that neurological function is an important determinant of outcome and more sensitive neurophysiological testing might be a useful prognostic tool.
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Randomized Controlled Trial Comparative Study Clinical Trial
New agents, the circle system and short procedures.
Sevoflurane, desflurane and isoflurane were compared using a circle system in 97 patients undergoing short surgical procedures. Using initial high flows, the time intervals to equilibration between inspired and end-expired agent concentrations were measured; equilibration was defined as FE/FI = 0.8. ⋯ After equilibration total flow were reduced to 500 ml.min-1; at these flows the initial decline in end-expired agent concentration was minimal with desflurane, intermediate with sevoflurane and greatest with isoflurane. Both desflurane and sevoflurane are appropriate for efficient use of the circle system during short anaesthetics.