British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Hormonal responses to high-dose fentanyl anaesthesia. A study in patients undergoing cardiac surgery.
The hormonal responses to anaesthesia and cardiac surgery were studied in 20 patients. Ten patients were anaesthetized with fentanyl 60 microgram kg-1 and nitrous oxide in oxygen and 10 with etomidate 0.3 mgkg-1 and nitrous oxide in oxygen plus halothane. ⋯ Patients anaesthetized with etomidate and halothane showed a significant increase in adrenaline and glucose concentrations not seen in the fentanyl group. Cardiopulmonary bypass was associated with marked increases in catecholamines in both groups.
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Interstitial fluid pressure (IFP) and plasma colloid osmotic pressure (plasma COP) were measured in dogs following acute haemorrhage and following the infusion of saline, 10% dextra 40 in saline and 3% dextran 40 in lactated Ringer's solution. Exsanguination decreased IFP, plasma COP and total plasma protein and albumin concentrations, and increased plasma glucose concentration and osmotic pressure. A massive infusion of physiological saline increased IFP, and decreased plasma COP and total plasma protein and albumin concentrations. ⋯ When a 10% dextran 40 saline solution was used, there was a marked increase in plasma COP but a decrease in IFP. When 3% dextran 40 in lactated Ringer's solution was infused, IFP was little affected in the early stage, but gradually increased thereafter. Plasma COP increased slightly immediately after infusion, but remained near the pre-exsanguination value for at least 3 h.
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A forearm tourniquet for i.v. regional analgesia of the hand, using doses of bupivacaine smaller than in the conventional (upper arm) method, produced successful analgesia in 98 of 102 patients. In 63 patients bupivacaine 50 mg or less was adequate, while in 33 the dosage was between 60 and 75 mg. No toxic effect was noted. This technique permits surgery of the hand, wrist and distal forearm.