British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Metabolic effects of induced hypotension with trimetaphan and sodium nitroprusside.
In two groups of patients undergoing induced hypotension with sodium nitroprusside or trimetaphan blood concentrations of lactate, pyruvate and standard bicarbonate did not differ significantly between the groups. In the nine patients who received trimetaphan there was a progressive, but statistically non-significant, decrease in mean lactate. ⋯ No relationship to dose rate of nitroprusside was found with these short-term infusions. It is concluded that sodium nitroprusside can be used safely for induced hypotension at doses less than 1.5 mg kg-1 and that simple blood-gas analysis is adequate for the assessment of toxic effects when greater doses are given.
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A simple apparatus and a method are described by which an exact end-point can be attained in inflating the bronchial cuff of a double-lumen tube, and accidental collapse of the cuff detected.
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In man the number of adverse responses to the Cremophor-containing anaesthetic agents Althesin and propanidid (Epontol) has been reported to be greater than that encountered with thiopentone. The response of the mini-pig to repeated injection of a range of i.v. anaesthetics and their solvents has been investigated in an attempt to ascertain the possible role of Cremophor in the production of these responses. A second injection of Cremophor EL or the Cremophor/Micellophor-containing agents Althesin and propanidid (Epontol), given 7 days after the first, produced a high frequency of adverse responses. ⋯ No abnormal responses were seen following the repeated administration of thiopentone. A marked increase in arterial pressure, and an immediate but transient marked decrease in the numbers of circulating polymorphonuclear leucocytes, were consistent findings in animals showing adverse responses. No abnormal responses were found when the interval between two administrations of Althesin was extended to 3 weeks.
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The cardiovascular effects of infusions of Althesin at various rates to supplement nitrous oxide anaesthesia have been studied in seven spontaneously breathing patients and11 patients ventilated artificially to normal PaCO2. During spontaneous breathing, increasing rates of Althesin infusion were associated with increases in heart rate and cardiac output. The modest decrease in arterial pressure (-5%) was the result of a decrease in vascular resistance. Increasing rates of Althesin rates of Althesin infusion (up to eight times the minimum infusion rate) caused dose-dependent decreases of arterial pressure and systemic vascular resistance, whereas heart rate and cardiac output were increased slightly at all rates of infusion.
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Letter Case Reports
Fire and explosion hazards in operating theatres: a reply and new evidence.