British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of high-dose fentanyl anaesthesia on the metabolic and endocrine response to cardiac surgery.
The effect of high-dose fentanyl anaesthesia (75 micrograms kg-1) on the metabolic and endocrine responses to cardiac surgery was compared with results obtained in similar patients who had received incremental doses of papaveretum. High-dose fentanyl anaesthesia prevented the increases in blood glucose, plasma cortisol and plasma growth hormone concentrations found before cardiopulmonary bypass, but during cardiopulmonary bypass was only effective in decreasing the hyperglycaemia. The continued administration of fentanyl following operation failed to suppress the hormonal and metabolic changes so that the total urinary excretion during the first 5 days after surgery was similar in both groups of patients. High-dose fentanyl anaesthesia was associated with only transient metabolic benefits confined to the period during operation.
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Two surgeons, in whom liver damage developed after occupational exposure to sub-anaesthetic doses of halothane, were found to have a circulating antibody which reacted specifically with halothane-altered hepatocyte membrane components. This antibody had been found previously only in those patients in whom severe hepatic necrosis developed after exposure to halothane and in no other form of liver injury. It may provide a specific diagnostic marker in patients in whom there are other possible causes of liver damage and could, therefore, remove the need for a challenge exposure and its attendant risks.
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Comparative Study
Effects of nitrous oxide and oxygen on tracheal tube cuff gas volumes.
The changes in the volume of the cuffs of 200 air-inflated tracheal tubes were studied on exposure to 70% nitrous oxide and 30% oxygen. The length of the cuff, its diameter, wall thickness and residual volume were measured. ⋯ The tracheal tubes with low-pressure cuffs were more permeable to nitrous oxide and oxygen than those with high-pressure cuffs. Implications of these findings and the factors which govern the transmission rates of gases through cuff material are discussed.
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Randomized Controlled Trial Clinical Trial
Use of di-isopropyl phenol as main agent for short procedures.
The use of di-isopropyl phenol (Diprivan) for induction of anaesthesia was assessed in doses ranging from 1 to 3 mg kg-1. With less than 1.75mg kg-1 not all patients were anaesthetized; 2.0 mg kg-1 appeared to be a satisfactory induction dose. Involuntary muscle movement, cough and hiccup at induction were rare with any dose studied. ⋯ Recovery was rapid, and characterized by lack of emetic sequelae. Di-isopropyl phenol 1.5 - 2.0 mg kg-1 given rapidly during reactive hyperaemia can produce anaesthesia in one arm-brain circulation time. A reaction involving flush, hypotension, cough, laryngospasm and bronchospasm occurred in one patient receiving 2.5 mg kg-1 given over 20 s.