British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Non-invasive measurement of cardiac output during induction of anaesthesia and tracheal intubation: thiopentone and propofol compared.
We have investigated the haemodynamic changes in response to induction of anaesthesia and tracheal intubation in patients who received either thiopentone 5 mg kg-1 or propofol 3 mg kg-1 followed by atracurium 0.5 mg kg-1 and fentanyl 1.5 micrograms kg-1. Anaesthesia was maintained with 0.6% enflurane and 50% nitrous oxide in oxygen with assisted ventilation. Cardiac output and heart rate (HR) were monitored continuously with a transthoracic impedence monitor. ⋯ Both variables increased from preinduction values 1 min after tracheal intubation (P less than 0.001). In contrast, both MAP and SVR decreased after induction in the propofol group (P less than 0.001) and did not differ from preinduction values 1 min after tracheal intubation. MAP and SVR were greater in the thiopentone group compared with the propofol group after induction and tracheal intubation (P less than 0.01).
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Comparative Study
Comparison of invasive and non-invasive measurements of continuous arterial pressure using the Finapres.
A comparison was made of arterial pressures measured invasively from a radial arterial cannula and non-invasively from the middle finger using the 2300 Finapres (Ohmeda) during induction and maintenance of anaesthesia. Digital outputs of both pressures were captured directly onto computer hard disk; data recorded during flushing of the arterial line were excluded from analysis. We studied 53 patients undergoing cardiac, major vascular and neurosurgical procedures; 17705 comparisons of systolic, diastolic and mean pressure were analysed. ⋯ However, patient data sets showed marked variability in average pressure differences (invasive minus Finapres) when examined individually or grouped by operation type. Unexplained variations in pressure difference with time and absolute pressure were observed also. Whilst providing useful beat-to-beat information on arterial pressure trends, the Finapres cannot be recommended as a universal substitute for invasive arterial pressure monitoring.
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Randomized Controlled Trial Clinical Trial
Effect of P6 acupressure on postoperative vomiting in children undergoing outpatient strabismus correction.
A prospective, double-blind study was conducted to compare the effect of pressure at the P6 (Neikuan) point with placebo as an antiemetic in children. Sixty-six patients, ages 3-12 yr, undergoing outpatient surgery for correction of strabismus, were allocated randomly to receive either bilateral P6 acupressure or placebo during the perioperative period. ⋯ The corresponding results for the acupressure group were 58% before discharge, 71% at home and 94% in the first 24 h. These differences were not significant; P6 acupressure did not reduce the incidence of postoperative vomiting in children undergoing strabismus surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of intense atracurium-induced neuromuscular block in children.
Antagonism of intense neuromuscular block induced by atracurium 0.5 mg kg-1 was attempted in four groups of six children using one of two doses of neostigmine (0.05 mg kg-1 and 0.1 mg kg-1) or of edrophonium (0.5 mg kg-1 and 1.0 mg kg-1) when the first twitch of the post-tetanic count (PTC1) was 10% of control. For comparison with normal practice, a fifth group received neostigmine 0.05 mg kg-1 when the first twitch of the train-of-four was 10% of control. ⋯ Doubling the doses of the anticholinesterases did not reduce the recovery time and had the effect of increasing variability. We conclude that there is no clinical advantage in attempting to antagonize intense neuromuscular block in children using normal or increased doses of neostigmine or edrophonium.
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We have examined the safety of induced hypotension produced by extradural anaesthesia in patients with medically controlled hypertension. The haemodynamic response to induced hypotension was assessed in 38 non-hypertensive and 31 controlled hypertensive patients. All received extradural anaesthesia to T4 or above which decreased mean arterial pressure to 52 mm Hg and 55 mm Hg in normotensive and hypertensive patients, respectively. ⋯ None developed acute renal failure or stroke. There were three deaths; one of a patient who had hypertension. This suggests that induced hypotension with extradural anaesthesia is a safe technique for patients with medically controlled hypertension undergoing total hip arthroplasty.