Annals of cardiac anaesthesia
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The haemodynamic effects of propofol -fentanyl anaesthesia (n=25) were compared with isoflurane-fentanyl anaesthesia (n=25) in patients with normal left ventricular ejection fraction (>45%) undergoing coronary artery bypass graft surgery under cardiopulmonary bypass. In the propofol group (Group P), anaesthesia was induced with midoazolam 2.5 to 5.0 mg, fentanyl 5mg/kg, pancuronium 0.1 mg/kg and propofol 1-2 mg/kg and was maintained with propofol infusion 10 mg/kg/hr till sternotomy, followed by 3 mg/kg/hr till skin closure. In the inhalational group (Group I) anaesthesia was induced with midazolam, fentanyl, pancuronium in the same doses and sleep dose of thiopentone and was maintained with oxygen : nitrous oxide (50:50) and isoflurane (0.5-1%). ⋯ Similarly post-bypass stroke volume index was higher in Group P (379.32 +/- 6.31 v/s 26.78 +/- 6.24, p<0.05). Patients in Group P were extubated earlier as compared to Group I (379.50 +/- 69 min v/s 453.00 +/- 134 min, p<0.05). This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with normal left ventricular ejection fraction undergoing coronary artery bypass graft surgery.
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Myasthenic gravis (MG) is an autoimmune disease associated with acetylcholine receptor deficiency. Patients with MG exhibit increased sensitivity to non-depolarising muscle relaxants. In an attempt to avoid neuromuscular blockers, we used sevoflurane in two myasthenic patients undergoing trans-sternal thymectomy. ⋯ In both patients anaesthesia was maintained with 1.5-2% end-tidal concentration of sevoflurane and nitrous oxide in oxygen without adjunctive neuromuscular blocking agents. There were minimal changes in cardiovascular variables and recovery was faster. It is suggested that sevoflurane may be the main anaesthetic for both induction and maintenance in myasthenic patients undergoing trans-sternal thymectomy.
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For many people cardiac arrest is a natural ending of a long and productive life. A substantial number of humans, however, are struck by this event too early in life with tragic consequences including financial problems for both family and society. A recent review of in-hospital cardiac arrests found a wide variation in the reported survival to discharge ranging from 0% to 28.9% with a mean of 14%1. ⋯ Bystander CPR is an important link in "the chain of survival" before more advanced interventions will be available at the scene. 4 CPR training programmes for lay people have been organised in many countries with millions of people trained in basic CPR. It is important to continue this education of lay people since at the moment early bystander CPR, besides defibrillation, is probably the single most important intervention. The concept of early activation of the emergency medical System, early basic life support (BLS), including precordial compression and artificial ventilation, early defibrillation, and early advanced cardiac life support (ACLS), could achieve 25-40% survival rates.3 These concepts for emergency cardiac care have been supported by the American Heart Association5 as well as the European Resuscitation Counil.6 Advanced cardiac life support protocols combine pharmacological and mechanical interventions to restore spontaneous circulation (ROSC) and is based on four components: early defibrillation, administration of drugs, ventilation (oxygenation), and circulatory support.
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To compare the haemodynamic effects and intubating conditions of rocuronium and vecuronium, 20 patients of either sex with poor left ventricular function (ejection fraction <35%) scheduled for coronary artery bypass surgery were randomly divided into two equal groups. All patients were premedicated with lorazepam and morphine and induced with morphine, midazolam, thiopentone and either vecuronium (0.1 mg/kg) or rocuronium (0.6 mg/kg) as muscle relaxant. All patients were intubated after 3 minutes in the vecuronium group and 90 seconds in the rocuronium group by the same anaesthesiologist. ⋯ The heart rate at 3 minutes and mean arterial pressure at 1 minute was higher in the vecuronium group as compared to the rocuronium group. There were no other significant haemodynamic differences in both the groups. We conclude that rocuronium does provide better intubating conditions at 90 seconds than vecuronium at 3 minutes with no significant differences in the haemodynamic parameters between the two; however, the train of four response does not correlate with intubating conditions.