British journal of anaesthesia
-
We studied effects on the EEG of propofol infused at a rate of 0.5 mg kg-1 min-1 for 10 min in 10 healthy male surgical patients under extradural analgesia. The EEG amplitude in six frequency bands was related to arterial blood propofol concentrations and responsiveness to verbal commands. The EEG amplitude showed a characteristic biphasic response to increasing blood propofol concentrations in all frequency bands. ⋯ Pharmacodynamic modelling, using two effect compartments with dissimilar equilibration constants, resulted in satisfactory fits. We conclude that propofol exerts a biphasic effect on the EEG amplitude in all frequency bands. The dissimilarity of EEG changes during infusion and during emergence suggests that two effect compartments with different equilibration constants exert opposing effects on the EEG.
-
We conducted a prospective survey on the incidence of respiratory complications associated with tracheal intubation and extubation in 1005 patients who underwent elective general anaesthesia over a 4-month period. During induction of anaesthesia, respiratory complications occurred in 46 patients (4.6%; 95% confidence limits (CL): 3.3, 5.9%). The common complications were coughing (1.5%) and difficult ventilation through a facemask (1.4%). ⋯ The incidence of complications was significantly higher immediately after tracheal extubation than during induction of anaesthesia (P < 0.001). Even when all incidents of coughing that occurred after tracheal extubation were disregarded as a complication, the overall incidence was still higher immediately after extubation (7.4%) than during induction of anaesthesia (P < 0.01). We conclude that the incidence of respiratory complications associated with tracheal extubation may be higher than that during tracheal intubation.
-
Holt-Oram syndrome (HOS) is a rare disorder characterized by congenital anomalies of the upper limbs and heart. Cardiac arrhythmias are common in patients with HOS. We successfully managed a 24-yr-old woman with HOS who underwent laparoscopic ovarian cystectomy. Potential problems in the anaesthetic management of patients with HOS are discussed.
-
Ropivacaine is considered safer than bupivacaine, on the basis of experimental and human data that indicate a lower systemic toxicity. Here we report the occurrence of a single seizure after i.v. administration of ropivacaine 120 mg intended for extradural block in a patient having postpartum, tubal ligation. The only prodromal symptom was nervousness, and the only cardiovascular manifestation was sinus tachycardia. Systemic toxicity, although less than that expected with bupivacaine, can occur with ropivacaine.
-
We have investigated the effects of intra-articular (i.a.) administration of ketorolac in the rat knee joint. Thirty Sprague-Dawley rats were given 0.25 ml of a standard preparation of ketorolac trometamol (10 mg ml-1) by injection into the right knee joint and 0.25 ml of 0.9% physiological saline solution by injection into the left knee as a control. Ten rats were killed at 24 h, 10 at 48 h and 10 at 5 days after injection. ⋯ These rats were then killed at 5 days (as this was the time interval after which we found the maximum inflammatory response in the earlier phase of our study). The joints were prepared and examined histologically. We feel that the absence of inflammatory changes in these joints make it unlikely that ethanol was responsible for the inflammation produced by ketorolac injection.