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 Comparative Study Clinical Trial
Sevoflurane compared with halothane for tracheal intubation in children.
We have studied 40 healthy children, aged 3-10 yr, undergoing adenotonsillectomy, in a double-blind, randomized study. Intubating conditions were assessed when the pupils had become small and central after inhalation induction with either 5% halothane and 60% nitrous oxide in oxygen or 8% sevoflurane and 60% nitrous oxide in oxygen. ⋯ Time to reach the clinical end-point for intubation was reached sooner with halothane (P = 0.015). In all children the trachea was intubated successfully at the first attempt and all remained haemodynamically stable throughout induction.
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Randomized Controlled Trial Clinical Trial
Effect of different doses of inhaled nitric oxide on pulmonary capillary pressure and on longitudinal distribution of pulmonary vascular resistance in ARDS.
Inhaled nitric oxide lowers pulmonary capillary pressure (PCP) in animals and in patients with acute respiratory distress syndrome (ARDS). A dose-response relationship in patients with ARDS has not yet been established. Therefore, we studied the effects of four concentrations of nitric oxide (1, 10, 20 and 40 volumes per million (vpm)) in random order, on PCP in 19 patients with ARDS. ⋯ In both groups, the nitric oxide-induced decrease in pre-capillary vascular resistance was small with a maximum effect at 1 vpm. In ARDS, vasodilatation of pre-capillary vessels is achieved at low concentrations of nitric oxide, whereas the effect of nitric oxide on postcapillary vessels is variable. Higher concentrations may be required for optimal post-capillary vasodilatation in a subgroup of ARDS patients.
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Minimally invasive direct coronary artery bypass grafting (MIDCAB) is becoming a popular adjunct to standard cardiac bypass surgery in selected patients with accessible single or double vessel disease. However, the limited anterior thoracotomy used to access the heart involves trauma to the muscle tissue during removal of the fourth costal cartilage and a small piece of connected rib, perhaps leading to more severe postoperative pain compared with patients undergoing routine sternotomy. Intrathecal opioids can be used but have limited therapeutic duration and there is concern regarding anticoagulation. We present a case where soft tissue catheters were placed into the depths of the surgical wounds and pain was diminished greatly by intermittent regular infiltration with bupivacaine.
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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.