British journal of anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
Intraocular pressure changes during rapid sequence induction of anaesthesia: comparison of propofol and thiopentone in combination with vecuronium.
Intraocular pressure (IOP) was measured during rapid sequence induction of anaesthesia using thiopentone or propofol as the induction agent and vecuronium for neuromuscular blockade. Vecuronium was administered in a dose of 0.15 mg kg-1 approximately 35 s before the induction agent. IOP was measured with a handheld applanation tonometer before anaesthesia, following administration of the induction agent, immediately after tracheal intubation and cuff inflation and 1, 2 and 3 min later. ⋯ IOP following intubation in patients in whom anaesthesia was induced with thiopentone was not significantly different from baseline values, but showed a significant increase from the pressure before intubation. In contrast, IOP after intubation in the propofol group remained not only significantly less than the baseline value, but also showed only a minimal and insignificant change in comparison with values before intubation. The frequency of side effects was low in both groups except for a significantly greater reduction in arterial pressure in those receiving propofol.
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Contralateral haemothorax developed as a late complication of subclavian vein cannulation following gradual erosion of the wall of the superior vena cava by the tip of the catheter. The use of a relatively rigid catheter and a left-sided approach may have contributed to this rare, but potentially fatal complication.
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The dynamic performance of arterial manometers depends upon the values of the natural frequency fo and the damping factor beta. Satisfactory reproduction of all arterial waveforms requires that fo should be greater than about 13 Hz; for an fo of 13 Hz, beta should have a value of 0.5, but, as fo increases, an increasing range of beta values is permissible. ⋯ We also investigated the performance of a commercial device, the Accudynamic, designed to allow beta to be increased without affecting fo. We found that the Accudynamic worked well, allowing acceptable performance to be obtained from the Gould Disposable transducer with catheters up to 200 cm in length.