British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Induction and emergence in infants less than 60 weeks post-conceptual age: comparison of thiopental, halothane, sevoflurane and desflurane.
We have studied 40 infants with a post-conceptual age of less than 60 weeks undergoing general anaesthesia for herniotomy. Patients were anaesthetized with 1 MAC equivalent values for age and agent and allocated randomly to receive halothane, savoflurane or thiopental for induction, and halothane, sevoflurane or desflurane for maintenance of anaesthesia. At induction, both time to acceptance of a face mask and loss of eyelash reflex were recorded. ⋯ Induction of anaesthesia in this population was no quicker with sevoflurane than with halothane and the method used for induction did not influence recovery time. Maintenance of anaesthesia with desflurane resulted in a shorter recovery time in infants in whom anaesthesia was induced with halothane or thiopental. Desflurane maintenance may be particularly beneficial in the neonate.
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Randomized Controlled Trial Clinical Trial
Effect of remifentanil on the haemodynamic response to orotracheal intubation.
We have examined the effect of remifentanil on the haemodynamic response to orotracheal intubation in a randomized, double-blind study. We studied 40 patients allocated to one of four groups of 10 each, to receive the following immediately before induction of anaesthesia: remifentanil 1 microgram kg-1 bolus over 30 s, followed by an infusion of 0.5 microgram kg-1 min-1; saline placebo only; glycopyrrolate 200 micrograms and remifentanil 1 microgram kg-1 bolus over 30 s, followed by an infusion of 0.5 microgram kg-1 min-1; or glycopyrrolate 200 micrograms only. Anaesthesia was induced with propofol, vecuronium and 1% isoflurane with 66% nitrous oxide in oxygen. ⋯ Arterial pressure and heart rate were measured non-invasively, immediately before induction of anaesthesia and then at 1-min intervals. Remifentanil was found to effectively attenuate the pressor response to intubation (P < 0.05 for the increase in mean arterial pressure; P < 0.01 for the increase in heart rate). In the absence of a concurrent vagolytic agent, remifentanil was associated with bradycardia or hypotension, or both, in five of 10 patients, compared with one patient who received remifentanil and glycopyrrolate.
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We have examined if sevoflurane anaesthesia per se modified the number of circulating leucocytes in humans. Fifty-nine patients undergoing elective surgery were anaesthetized with sevoflurane in oxygen. ⋯ While the total number of leucocytes remained constant, circulating neutrophils decreased (mean 3370 (SD 1030) mm-3 to 3170 (940) mm-3; P < 0.01) and lymphocytes increased (1870 (520) mm-3 to 2040 (580) mm-3; P < 0.01). We conclude that high concentrations of sevoflurane modified the distribution of leucocytes in anaesthetized patients.
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We have examined the short-term effects of three volatile anaesthetics, halothane, isoflurane and desflurane, on mucociliary activity in the rabbit maxillary sinus in vivo. Mucociliary activity was recorded photoelectrically and the signal processed by fast Fourier transformation. Administration of 1.0 MAC of halothane, isoflurane or desflurane caused a temporary increase in mucociliary activity, with mean peak responses of 47.8 (SEM 13.0)%, 44.0 (9.6)% and 45.1 (23.7)% (n = 6), respectively. ⋯ Atropine pretreatment did not affect, whereas CP-99 significantly reduced, the response to desflurane. We conclude that the NK1-mediated response was most pronounced for desflurane which is considered the most airway irritating compound of the three. It is likely that the size of the NK1-mediated response reflects the airway-irritating properties of the volatile anaesthetic used.
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Biography Historical Article Classical Article
Stimulus frequency in the detection of neuromuscular block in humans. 1970.