British journal of anaesthesia
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A retrospective review over 6 yr of patients presenting to the hand clinic was performed to identify cases of postoperative brachial plexopathy (PBP) and to assess both prognosis and early indices of prognosis. Over this period (1989-1995), 22 patients were referred by the hospital's surgical departments to the hand clinic because of PBP. Eight cases followed open heart surgery (OHS) and 14 followed non-cardiac surgery (NCS). ⋯ At a 1 week "prognostic milestone", 79% of NCS patients with significant symptomatology enjoyed complete recovery although this took as long as 5 months to 1 yr in 50% of patients. At a 6-8 week "prognostic milestone", 50% of those who had not yet had improvement in the motor deficit suffered residual neurological deficit. All patients recovered to a significant extent even when recovery was not complete and none suffered from late deterioration or chronic pain.
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We describe a six-compartment physiological model of the kinetics and dynamics of induction of anaesthesia with propofol in sheep. It includes a faithful description of initial bolus kinetics caused by accurate representations of the inter-relationships between initial vascular mixing, lung kinetics and cardiac output, the use of the brain as the target organ for propofol anaesthesia (two-compartment sub-model with slight membrane limitation), a description of the effects of propofol-induced changes in cerebral blood flow and a combined description of systemic kinetics as two tissue pools. Variables for the model were estimated from an extensive in vivo data set using hybrid modelling. Propofol was characterized by rapid transit through the lungs, but a slower transit time though the brain, leading to significant delay between arterial blood concentrations and cerebral effects.