British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Influence of hypertonic volume replacement on the microcirculation in cardiac surgery.
We have studied the effects of two types of volume replacement on the microcirculation in an open, controlled study in 45 patients undergoing aorto-coronary bypass grafting whose pulmonary capillary wedge pressure (PCWP) was less than 5 mm Hg. Hypertonic saline prepared in hydroxyethylstarch solution (HS-HES, n = 15) and 6% HES 200/0.5 solution (6% HES; n = 15) were infused randomly before operation in order to double the PCWP. Patients not given an infusion served as controls (n = 15). ⋯ Plasma viscosity decreased after infusion of HS-HES and increased slightly in control patients (+4%). In comparison with the 6% HES and particularly with the control group, LDF was significantly greater after infusion of HS-HES (forearm +80%; forehead +28%). LDF during CPB and thereafter was always greater than baseline values in the HS-HES group, whereas after bypass LDF was reduced in the 6% HES (-5%) and particularly in the control patients (-30%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketamine for caudal analgesia in children: comparison with caudal bupivacaine.
Fifty children undergoing inguinal herniotomy were allocated randomly to three groups to receive a caudal injection of either 0.25% bupivacaine 1 ml kg-1 with or without ketamine 0.5 mg kg-1 or ketamine 0.5 mg kg-1 with normal saline 1 ml kg-1. There was no significant difference in quality of pain relief, postoperative behaviour or analgesic requirements between the ketamine group and the two other groups. The bupivacaine-ketamine mixture provided better analgesia than the bupivacaine solution alone. Side effects such as motor weakness or urinary retention were not observed in the ketamine group.
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Randomized Controlled Trial Clinical Trial
Propofol and midazolam act synergistically in combination.
We have studied interactions between i.v. propofol and midazolam for induction of anaesthesia in 200 unpremedicated female patients undergoing elective gynaecological surgery. Using end-points of "hypnosis" (loss of response to verbal command) and "anaesthesia" (loss of response to a 5-s transcutaneous tetanic stimulus), we determined dose-response curves for propofol and midazolam alone and in combination. ⋯ The reduction in arterial pressure at induction was the same for the combination as for the individual agents. The cause of the synergism was not clear, but may have been interaction at CNS GABAA receptors.