Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Alfentanil in minor gynaecological surgery: use with etomidate and a comparison with halothane.
Etomidate was used to induce anaesthesia in 50 healthy subjects undergoing minor gynaecological surgery who were randomly divided into two groups, one receiving alfentanil 8 micrograms/kg intravenously immediately prior to induction of anaesthesia with etomidate, and the other halothane as required to maintain adequate anaesthesia. There was a highly significant reduction in the incidence of myoclonia and involuntary movement and significant reduction of pain on injection in the alfentanil group. Tests of recovery performed in the 60 minutes following anaesthesia suggested that supplementation with alfentanil led to more rapid recovery than halothane.
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A prospective study was completed of 30 shocked patients admitted consecutively to an intensive therapy unit; the majority of the patients had shock of septic origin. Measurements were made of whole blood lactate together with mean arterial pressure, hourly urine volume and core: peripheral temperature difference at the start of treatment and 3 and 24 hours later. Serial lactate measurements were better at predicting outcome than single measurements. However, lactate measurements were much less valuable than serial measurements of the simple haemodynamic variables.
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An inflatable neck tourniquet has been developed for compression of the jugular veins during neurosurgery in the sitting position. Neck compression abolishes the subatmospheric pressure within the neck veins and therefore minimises the risk of air embolism. Compression can be applied throughout the initial part of the operation, a major period of risk during these surgical procedures, and released once full surgical exposure has been achieved. Venous congestion is then released and normal operating conditions are restored.
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Randomized Controlled Trial Comparative Study Clinical Trial
Plasma catecholamine concentrations. The effects of infiltration with local analgesics and vasoconstrictors during nasal operations.
Plasma catecholamine concentrations were measured in 19 patients allocated randomly to receive submucous infiltration with 4 ml of either 0.5% lignocaine with adrenaline 1:200 000 or prilocaine 0.5% with octapressin 0.03 iu per ml. Venous blood samples were obtained before and at 2, 5, and 10 minutes following infiltration. Plasma adrenaline increased from 0.35 to 1.72 p mol/ml at 2 minutes infiltration with the former solution whilst there was little change in plasma noradrenaline concentration. No similar peak in adrenaline concentration occurred after infiltration with prilocaine/ octapressin solutions but with both solutions there was a small increase in plasma noradrenaline and adrenaline concentrations 10 minutes after infiltration, at the time of surgical stimulation.
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Comparative Study
Infusion analgesia for acute war injuries. A comparison of pentazocine and ketamine.
Continuous intravenous infusions of ketamine and pentazocine have been used to provide analgesia in 18 patients with acute war injuries. The drugs were given alternately. ⋯ Arterial blood pressure and respiratory rate were maintained following ketamine but tended to fall after pentazocine. It is suggested that ketamine would be the better agent in patients with hypovolaemia or respiratory depression.