British journal of anaesthesia
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We have recorded auditory evoked potentials before and during cardiopulmonary bypass in 10 adult patients undergoing cardiac surgery under moderate hypothermia to 27-28 degrees C. The immediate effect of bypass was a small decrease in latency and increase in amplitude of the early cortical response. ⋯ Reduction in core temperature to 25 degrees C resulted in an increase in latency and amplitude of the brain stem responses; below this temperature the amplitude decreased but latency continued to increase until the auditory evoked response trace became completely flat between 21 and 19 degrees C. These changes were reversible on rewarming.
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Case Reports
Pregnancy complicated by aortic dissection: caesarean delivery during extradural anaesthesia.
We report a case where dissection of the aorta occurred in pregnancy; only medical management was undertaken. Delivery was by Caesarean section during extradural anaesthesia and was accomplished safely several weeks after the dissection. The aetiology, association with pregnancy, diagnosis and management of acute dissection of the aorta are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery after electroconvulsive therapy: comparison of propofol with methohexitone anaesthesia.
We have studied prospectively 39 patients receiving a course of electroconvulsive therapy (ECT) for major depressive disorder; they were allocated randomly to receive either propofol or methohexitone for anaesthesia. Recovery after the third ECT treatment was assessed by finger tap and digit symbol substitution tests at 15, 30, 45, 60 and 90 min after induction. ⋯ There was no significant difference in psychometric recovery for drug type, duration of the seizure or initial severity of depression. These results suggest that the more rapid recovery rates noted with propofol in other procedures are not evident after electrically induced seizures.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of an amethocaine gel preparation for percutaneous analgesia before venous cannulation in children.
We have evaluated the efficacy and safety of a preparation of 4% amethocaine gel in alleviating the pain of venous cannulation in children. In an initial open study of 148 children, clinically acceptable anaesthesia was achieved in 92% of cases. ⋯ There were no significant adverse effects noted in each group, although 37% of those children treated with amethocaine gel showed localized erythema at the application site. The results suggest that amethocaine gel has greater efficacy and a faster onset time than EMLA cream when used for this purpose in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of desflurane and isoflurane in anaesthesia for dental surgery.
We studied 50 ASA I-II patients, aged 18-65 yr, undergoing elective orofacial surgery. Anaesthesia was induced with fentanyl and propofol, and maintained with 66% nitrous oxide in oxygen and either desflurane or isoflurane to compare recovery characteristics and cardiovascular stability. Cardiovascular responses to induction, intubation and incision were similar with both agents, although the increase in heart rate in response to intubation was less marked in the desflurane group. ⋯ Mean duration of anaesthesia was 46 (SD 17.9) min (range 25-89 min) in the desflurane group and 41 (11.5) (23-60) min in the isoflurane group. Times to extubation were 6.7 (2.1) (3-10) min and 11.3 (4.1) (5-23) min, to eye opening 6.8 (2.2) (3-11) min and 12.7 (6.9) (7-37) min, to stating date of birth 9.0 (2.3) (4-12) min and 15.0 (6.9) (8-39) and to discharge from the recovery room 45 (11.6) (22-80) min and 64 (20.9) (28-134) min, for the desflurane and isoflurane groups, respectively (all P < 0.0001). No serious complications occurred in any patient.