Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between propofol and ketamine for anaesthesia in the elderly. Haemodynamic effects during induction and maintenance.
The haemodynamic effects of propofol and ketamine were studied in two groups of eight randomly allocated elderly patients (mean age 85.8 years) anaesthetised for hip replacement. Group 1 patients patients received propofol 1 mg/kg by intravenous bolus for induction and 0.1 mg/kg/minute by continuous infusion for maintenance. Group 2 patients received ketamine 1.5 mg/kg by intravenous bolus as induction dose and 50 micrograms/kg/minute by continuous infusion for maintenance. ⋯ Myocardial oxygen consumption showed a significant decrease of 27%. There was a significant increase in blood pressure and pulmonary capillary wedge pressure (by 97%) in group 2. Cardiac output and systemic vascular resistance remained unchanged whereas myocardial oxygen consumption showed a very significant increase of 100%.
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Comparative Study
Bladder temperature as an estimate of body temperature during cardiopulmonary bypass.
Bladder temperature measured by a thermistor-tipped urinary catheter, was compared to oesophageal, nasopharyngeal, rectal and cutaneous temperatures in 33 patients during cardiopulmonary bypass. The bladder site was warmer than all other monitored sites in the pre-bypass period and showed least variation in temperature. The rate of change of bladder temperature during cooling and rewarming on bypass was significantly (p less than 0.01) lower than for oesophageal and nasopharyngeal temperatures, but was greater than or similar to the rate of change of rectal and cutaneous temperatures. This method of temperature measurement was found to be satisfactory during major surgery and also during the postoperative period in the intensive care unit.
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Twenty patients, ASA grades 1 and 2, aged 18-65 years were admitted to an open study to investigate the ease of tracheal intubation after induction of anaesthesia with propofol without the use of muscle relaxants after the chance observation that propofol 2.5 mg/kg allowed easy laryngoscopy and tracheal intubation. Satisfactory intubation conditions were achieved in 19 patients.
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The effects of a bolus injection of propofol on mean intracranial pressure were studied in six adult, comatose patients who had severe head injuries. Propofol 2 mg/kg was given intravenously over 90 seconds when the mean intracranial pressure reached or exceeded 25 mmHg. Arterial blood gas values, heart rate and central venous pressure remained stable at all measurements. ⋯ The mean (SEM) intracranial pressure decreased statistically significantly (p less than 0.05) at 30 seconds and at 1 and 2 minutes, from 25 (3) to 11 (4) mmHg. The cerebral perfusion pressure decreased statistically significantly from 92 (8) mmHg at all measurements (p less than 0.05). The lowest value at 3 minutes was 50 (7) mmHg but in four patients at that time the perfusion pressure was below 50 mmHg.
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A 30-year-old woman developed severe chest pain while out shopping and was admitted to the delivery suite. She was 38 weeks pregnant with her second child. ⋯ She went into spontaneous labour 30 hours later and was delivered vaginally. This report reviews myocardial infarction in pregnancy and considers the clinical management of this patient.