British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of fentanyl and halothane supplementation to general anaesthesia on the stress response to upper abdominal surgery.
The stress response to surgery and anaesthesia was studied in 20 patients undergoing cholecystectomy or vagotomy and pyloroplasty. Patients were anaesthetized with thiopentone and nitrous oxide; 10 patients received supplements of 0.5-1.5% halothane and the others fentanyl (mean 17 micrograms kg-1). ⋯ The hyperglycaemic response in the halothane group was greater than in the fentanyl group. Plasma noradrenaline concentrations increased in the group receiving halothane, but did not increase significantly in the group receiving fentanyl.
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Comparative Study
Maternal and umbilical cord plasma noradrenaline concentrations during labour with and without segmental extradural analgesia, and during caesarean section.
Serial measurements of maternal and umbilical cord plasma noradrenaline concentrations were obtained in 10 patients undergoing normal vaginal delivery with segmental extradural analgesia, in 10 patients undergoing normal vaginal delivery without extradural analgesia, and in 12 patients undergoing elective Caesarean section under general anaesthesia. Maternal noradrenaline concentrations increased significantly during delivery in all three groups, the peak concentrations occurring at delivery. ⋯ However, extradural analgesia did not affect the fetal noradrenaline concentrations. Since noradrenaline is probably required for the adaptation of the newborn to extrauterine life, the unaltered fetal response may be beneficial.
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Minute ventilation (VE) (ml min-1), respiratory frequency (f), mixed expired carbon dioxide fraction (FECO2) and end-tidal carbon dioxide concentration (E'CO2) (%) were measured, and alveolar ventilation (VA), deadspace (VD), deadspace/tidal volume ratio (VD/VT) and carbon dioxide output (VCO2) calculated in 58 anaesthetized, spontaneously breathing infants and children weighing 2.8-20.5 kg. Although minute volumes varied, tidal volume correlated well with weight (r = 0.83), with a mean tidal volume (+/- 1SD) of 5.2 +/- 1.2 ml kg-1. ⋯ Respiratory frequency, VD/VT and total VD per minute were higher in the younger age group, which explained the finding of a high VE in relation to VCO2 for these patients. This inefficiency of ventilation emphasizes the need to minimize apparatus deadspace in breathing systems used for small infants.
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Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with an atrial septal defect. Death occurs usually from cardiac arrhythmias. The successful use of a two-catheter technique for elective Caesarean section with extradural analgesia is described and the hazards associated with Ebstein's anomaly in pregnancy and anaesthesia are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Venous sequelae following the injection of etomidate or thiopentone i.v.
The frequency of local venous reactions after the injection i.v. of etomidate or thiopentone was studied in 61 patients undergoing surgery for prolapsed lumbar disc. Of the patients who received etomidate, 24% developed thrombophlebitis in the period after operation (up to 14 days). Of the patients who received thiopentone, 4% developed thrombophlebitis in the period after operation. Pain on injection occurred in 24% of the patients receiving etomidate, but there was no correlation between pain on injection and the subsequent thrombophlebitis.