British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation.
The catecholamine and cardiovascular responses to laryngoscopy alone have been compared with those following laryngoscopy and intubation in 24 patients allocated randomly to each group. Following induction with fentanyl and thiopentone, atracurium was administered and artificial ventilation undertaken via a face mask for 2 min with 67% nitrous oxide in oxygen. Following laryngoscopy, the vocal cords were visualized for 10 s. ⋯ Arterial pressure, heart rate and plasma noradrenaline and adrenaline concentrations were measured before and after induction and at 1, 3 and 5 min after laryngoscopy. There were significant and similar increases in arterial pressure and circulating catecholamine concentrations following laryngoscopy with or without intubation. Intubation, however, was associated with significant increases in heart rate which did not occur in the laryngoscopy-only group.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of topical lignocaine on the sympathoadrenal responses to tracheal intubation.
The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation have been studied in 30 patients undergoing elective gynaecological surgery, allocated randomly to one of three groups: group 1 received 4% lignocaine 160 mg using a Forrester Spray; group 2 received 4% lignocaine 160 mg by "Laryng-o-jet"; group 3 received an equal volume of saline administered by Forrester Spray. In all three groups, there were similar and statistically significant increases in mean arterial pressure and plasma adrenaline and noradrenaline concentrations 1 min after intubation, with diminution of these responses by 5 min after intubation. There were no differences between the three groups at any stage, which suggests that topical anaesthesia of the mucosa of the upper airway, as performed conventionally, is ineffective as a means of ameliorating the pressor and catecholamine responses to routine laryngoscopy and intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia for evacuation of retained products of conception. Comparison between alfentanil plus etomidate and fentanyl plus thiopentone.
Forty-four patients presenting for evacuation of retained products of conception were anaesthetized with either fentanyl and thiopentone, or alfentanil with etomidate, along with 70% nitrous oxide in oxygen. There was no difference between the two techniques in indices of immediate recovery (time to opening eyes and obeying a simple command), but the rate of return of higher mental functions (assessed by a coin counting test) was significantly better using the alfentanil-etomidate technique. There was no statistically significant difference between the techniques for apnoea or abnormal movements during anaesthesia, but alfentanil with etomidate was associated with significantly more pain on injection and a higher frequency of postoperative vomiting (40%).
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic effects of vecuronium, pancuronium and atracurium in patients with coronary artery disease.
Thirty patients with ischaemic heart disease scheduled for coronary artery bypass grafting were randomly allocated to three equal groups. Following morphine, hyoscine and pentobarbitone premedication, anaesthesia was induced with diazepam 0.3 mg kg-1. Five minutes later neuromuscular blockade was induced with pancuronium 0.1 mg kg-1, vecuronium 0.1 mg-1 or atracurium 0.5 mg kg-1, followed after 6 min by fentanyl 25 micrograms kg-1. ⋯ Systemic vascular resistance decreased significantly from 1515 dyn s cm-5 to 1200 dyn s cm-5 following atracurium. Cardiac index was increased transiently in the atracurium group, but a more sustained increase was observed following pancuronium. Nine patients in the atracurium group showed skin flushing and one developed skin weals.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of gravity on the spread of extradural anaesthesia for caesarean section.
The effect of gravity on the spread of extradural anaesthesia was evaluated in a series of parturients undergoing elective Caesarean section. Following placement of an extradural catheter, 25 patients were placed 30-40 degrees head-up for 20 min during the administration of the local anaesthetic drug; 25 additional patients remained supine during injection. ⋯ There were no differences in the rate of onset of sacral blockade or in the extent of neural blockade between the two groups. The semi-upright position was not necessary to ensure adequate sacral anaesthesia for Caesarean section.