British journal of anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of diazepam and flunitrazepam as adjuncts to general anaesthesia in preventing arousal following surgical stimuli.
A comparison has been made between the effects of the administration of flunitrazepam 1 mg i.v. and diazepam 10 mg i.v. in 90 female patients undergoing abdominal surgery. The drugs were given immediately before the skin incision as a booster to the induction agent thiopentone. The response to the incision, the quality of anaesthesia and the need for supplementary medication during maintenance were monitored. ⋯ The frequency of nausea after operation was low. The post-anaesthesia interview revealed that flunitrazepam possesses a more specific anterograde amnesic action than diazepam. Acceptability of the anaesthesia to the patient was equally good in both groups.
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Comparative Study
Extradural analgesia for caesarean section: a comparison with general anaesthesia.
Thirty-two patients received lumbar extradural anaesthesia for elective Caesarean section. The results obtained from this series were compared with those from a similar (control) group of parturients who received general anaesthesia. ⋯ Infants sustained respiration more rapidly after regional blockade, otherwise the clinical condition of the infants was similar with extradural and general anaesthesia. No advantage of conduction over general anaesthesia was evident from this study, with respect to the biochemical status of the infant at birth.
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Ten patients with intracranial lesions, anaesthetized with thiopentone and nitrous oxide (70%) in oxygen (30%) received etomidate 0.2 mg kg-1 i.v. Ventilation was controlled in each patient. Intracranial pressure (i.c.p.) and mean arterial pressure (m.a.p.) were recorded. ⋯ M.a.p. decreased in most patients, but the decrease was statistically significant only at 3 and 4 min after the administration of etomidate (0.05 greater than P greater than 0.02). The changes in cerebral perfusion pressure (c.p.p.) and heart rate were not clinically or statistically significant. We conclude that etomidate can be used for the induction of anaesthesia in patients with intracranial space-occupying lesions without increasing i.c.p. or seriously reducing c.p.p.
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The use of small endotracheal tubes reduces the trauma of intubation. Ventilator and tracheal pressures were measured during controlled ventilation with various tube dimensions and ventilation volumes. Ventilation with large volumes using small tracheal tubes results in high ventilator pressures. ⋯ Small endotracheal tubes and high ventilation volumes result in a positive tracheal pressure at the end of expiration. The measured end-expiratory pressures are within the limits which might be used therapeutically (in PEEP). The force required to reshape endotracheal tubes of varvious dimensions to an "anatomical" shape was related to the tube dimensions; the beneficial effects of performed, "anatomically shaped" endotracheal tubes can be achieved by using small tubes of standard design.