British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients.
The mortality following surgical correction of upper femoral fractures was investigated in 578 patients, over the age of 50 yr, randomly allocated to receive spinal (bupivacaine) or general (enflurane or neurolept) anaesthesia. Thirty days after surgery the mortality was 6% after spinal and 8% after general anaesthesia (ns). ⋯ The estimated blood loss was smaller (P less than 0.05) in patients receiving spinal anaesthesia. Regardless of the anaesthetic technique, a high short-term mortality was related to age, male sex, and trochanteric fracture, whereas excess long-term mortality was related to male sex and high ASA scores.
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Randomized Controlled Trial Clinical Trial
Haemodynamic effects of pretreatment with metoprolol in hypertensive patients undergoing surgery.
Thirty hypertensive patients scheduled for cholecystectomy or hernia repair under general anaesthesia with thiopentone-fentanyl-nitrous oxide-pancuronium were divided into two groups of 15. One group received metoprolol tablets 200 mg in a slow release form, once daily for at least 2 weeks including the morning of surgery. In addition, metoprolol 15 mg was injected i.v. shortly before the induction of anaesthesia. ⋯ Central venous pressure (CVP) and pulmonary arterial occlusion pressure (PAOP) increased significantly in both groups in response to the surgical stimulus. There was no significant difference between the groups in PAOP and CVP. One patient in the metoprolol group had marked bradycardia (minimum heart rate 26 beat min-1) after neostigmine and atropine; otherwise metoprolol pretreatment was tolerated well.
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Letter Randomized Controlled Trial Clinical Trial
Intercostal nerve blockade.
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Physiological (VDphys) and anatomical (VDanat) deadspaces were measured in seven anaesthetized, paralysed and intubated adult patients ventilated at normal and high frequencies. To maintain a constant PaCO2 while increasing the ventilation frequency from 15 to 120 b.p.m., the mean VT was decreased from 454 +/- 62 ml (mean +/- SD) to 117 +/- 9 ml. ⋯ This study showed that the deadspace volume measured conventionally was not a constant factor, was mainly a function of VT and was a determinant of tidal and minute volume requirement even during high frequency ventilation. The variable VDphys showed a wide variation between subjects, and appeared to have a mean minimal value of approximately 1.1 ml kg-1 at 80 b.p.m. in adult human subjects with a tracheal tube in situ--a value about half the VDphys measured at conventional normal tidal volumes and ventilation frequencies.