British journal of anaesthesia
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Letter Case Reports
Atracurium v. suxamethonium in a case of organophosphorous poisoning.
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The potential mutagenicity of isoflurane was investigated by the sister chromatid exchange (SCE) test using peripheral blood lymphocytes from patients before and after anaesthesia. Thirty patients, aged 18-59 yr (median 29.5 yr), were anaesthetized for minor orthopaedic operations with isoflurane and nitrous oxide in oxygen for 37-90 min (median 64 min). Venous blood samples were drawn before the induction of anaesthesia, immediately after completion of anaesthesia and on the following day. ⋯ In 11 cigarette-smoking patients (average 10 cigarettes per day), SCE was increased the day after operation when compared with SCE before the induction of anaesthesia (P less than 0.02). This might reflect differences in SCE formation attributable to the patients' smoking habits, but further studies of SCE in cigarette smokers are required to elucidate this. It was concluded that there was no indication, from the SCE test, of a mutagenic effect of short-term exposure to anaesthetic concentrations of isoflurane and nitrous oxide in oxygen.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of ketamine anaesthesia on the metabolic response to pelvic surgery.
The effects of ketamine anaesthesia on the metabolic and endocrine response to pelvic surgery were investigated, and compared with results obtained in a control group of patients anaesthetized with thiopentone and halothane. Ketamine anaesthesia before the onset of surgery was associated with a significant increase in blood glucose and plasma cortisol concentrations, and in heart rate. However, when surgery was established there were no metabolic, endocrine or haemodynamic differences between ketamine and halothane anaesthesia. We conclude that ketamine does not exacerbate the metabolic response to surgery.
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Evidence of central nervous system toxicity was noted in two patients undergoing extradural analgesia for Caesarean section. There was no cardiovascular depression and both patients recovered rapidly. The patients had received total doses of bupivacaine plain solution of 357.5 mg and 356.25 mg, respectively and the relationship of these to the clinical signs of bupivacaine toxicity is discussed.