British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of premedication on etomidate anaesthesia.
The effect of premedication upon the induction of anaesthesia with etomidate was studied in 74 adult patients undergoing elective orthopaedic surgery. Premedication with fentanyl plus atropine or with diazepam plus atropine decreased the frequency of involuntary muscle movements without modifying the pattern of the circulatory effects of etomidate, although fentanyl increased the frequency of apnoea. Pain at the site of injection was not modified by premedication.
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A simple valve device is described for a co-axial tubing anaesthetic system which enables selection of the circuit characteristics of either a modified Mapleson A system for spontaneous breathing or a modified Mapleson D system for controlled ventilation. Thus, the system allows an economical fresh gas flow to be used during either controlled or spontaneous ventilation. The mode of ventilation may be changed during anaesthesia without adjusting the patient tubing or the attachment of the system to the anaesthetic machine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of etomidate in combination with fentanyl or diazepam, with thiopentone as an induction agent for general anaesthesia.
In 104 premedicated patients undergoing general surgery, anaesthesia was induced either with etomidate 0.3 mg kg-1 preceded by fentanyl 1.25 or 2.5 microgram kg-1 i.v.or diazepam 0.0625 or 0.125 mg kg-1 i.v., or with thiopentone preceded by fentanyl 1.25 microgram kg-1 i.v. Despite the use of fentanyl or diazepam, the frequency of pain on injection in patients receiving etomidate was between 32% and 53%, being rated as severe in 5-20% of patients. ⋯ The frequency of both pain and involuntary muscle movements was least when fentanyl 2.5 microgram kg-1 preceded the administration of etomidate. There was no significant relationship between the pain and muscle movement; three of 10 patients given etomidate into a central vein had such movements.
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Clinical Trial Controlled Clinical Trial
Ketamine infusions: pharmacokinetics and clinical effects.
The clinical effects and pharmacokinetics of ketamine, administered as an i.v. infusion, were studied in 31 patients. Anaesthesia was induced with ketamine 2 mg kg-1 i.v. and maintained using an i.v. infusion of ketamine, supplemented by nitrous oxide. The plasma concentrations of ketamine, nor-ketamine and dehydro-nor-ketamine were analysed using gas-liquid chromatography. ⋯ Maximum concentration of nor-ketamine was 4.7 +/- 2.4 mumol litre-1 and of dehydro-nor-ketamine 3.2 +/- 1.9 mumol litre-1. There were transient increases (15-30% of pre anaesthetic values) in arterial pressure, heart rate and cardiac output during operation. No post-operative respiratory depression was seen.