British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation: comparison between propofol and thiopentone.
We have studied the haemodynamic changes, QT intervals and catecholamine responses to induction of anaesthesia and tracheal intubation in 24 ASA I patients allocated randomly to receive either propofol 2.5 mg kg-1 or thiopentone 5 mg kg-1 over 60 s. After disappearance of the eyelash reflex, the lungs were ventilated with 100% oxygen for 3 min. The trachea was intubated after administration of vecuronium. ⋯ One patient in the thiopentone group with a significantly prolonged QT interval had episodes of bigeminy and ventricular tachycardia. In both groups, concentrations of noradrenaline in mixed venous plasma increased after intubation (P < 0.001). Concentrations of adrenaline increased after intubation only in the thiopentone group (P < 0.001).
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Randomized Controlled Trial Clinical Trial
Diclofenac and ketoprofen for pain treatment after elective caesarean section.
We have studied the effect of a constant infusion of diclofenac 150 mg/24 h, ketoprofen 200 mg/24 h or placebo on postoperative pain after elective Caesarean section performed under spinal or extradural block in 90 patients in a prospective, randomized and double-blind study. During the first 24 h after operation, patients in the treatment groups were more comfortable than the placebo group (P < 0.005); the diclofenac group needed a mean of oxycodone 21.6 mg/24 h and the ketoprofen group 21.2 mg/24 h, compared with 38.3 mg/24 in the placebo group (P < 0.001); the mean time to the first injection of oxycodone was 270.5 min in the diclofenac group, 270.2 min in the ketoprofen group and 161.2 min in the placebo group (P < 0.001). ⋯ One patient in the diclofenac group was eliminated from the study because of uterine relaxation during the first 30 min after start of the drug infusion; this improved after cessation of diclofenac and infusion of sulprostone. There were no other serious side effects.
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Comparative Study
Plasma catecholamines and neonatal condition after induction of anaesthesia with propofol or thiopentone at caesarean section.
Increased maternal sympathetic nervous system activity may decrease placental perfusion and cause adverse neonatal effects. We have studied the catecholamine response and neonatal outcome in Chinese patients with uncomplicated, singleton pregnancies undergoing Caesarean section. Anaesthesia was induced with thiopentone 4 mg kg-1 (n = 32) or propofol 2 mg kg-1 (n = 30) followed by suxamethonium. ⋯ Maximum noradrenaline concentrations were greater in the thiopentone group (413 (177) pg ml-1) compared with the propofol group (333 (108) pg ml-1) (P < 0.05), but there were no differences between groups in adrenaline concentrations. Neonatal Apgar scores, neurobehavioural testing and umbilical catecholamine, blood-gas tension and oxygen content analysis were similar between groups. Propofol attenuated the hypertensive and catecholamine response associated with laryngoscopy and tracheal intubation but there was no improvement in neonatal outcome.
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Comparative Study
Comparison of portable emergency ventilators using a lung model.
A lung model was used to test the performance of five emergency ventilators (MEDUMAT Elektronik, MEDUMAT Variabel, OSIRIS, OXYLOG and rescuPAC 2DM). The model comprised two glass jars filled with water to suitable compliances and connecting tubes. ⋯ Preset minute volume was compared with measured minute volume and the gas distribution produced by the different ventilators. Acceptable performance was found with the MEDUMAT Elektronik, MEDUMAT Variabel, OSIRIS and OXYLOG ventilators.
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Analysis of small oscillations in heart rate (known as heart rate variability or HRV) associated with the activity of homeostatic reflexes can provide a noninvasive measure of autonomic reflex function. We have investigated the effects of surgical stimulation on autonomic reflex function by assessment of changes in HRV. Healthy female patients undergoing laparoscopic tubal ligation were anaesthetized with either thiopentone-nitrous oxide-isoflurane (group I; n = 13) or continuous propofol infusion (group P; n = 13). ⋯ Compared with control values, measurements of HRVtot before incision were reduced significantly in both groups (group P: 16 (SEM 3)% of control; group I: 2.5 (0.7)% of control). With surgical stimulation, mean HRVtot in group P was restored to 55 (13)% of control (P < 0.01 compared with measurement before incision), whereas mean HRVtot in group I remained at less than 4% of control (ns). %HRVlo increased also in group P, from 49 (7)% to 75(3)% (P < 0.05), consistent with a shift in sympathetic-parasympathetic balance towards sympathetic dominance. These results suggest that surgical stimulation may have significant effects on the autonomic reflexes mediating HRV, and that such effects vary with anesthetic technique.