Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1989
The effects of propofol on intracranial pressure and cerebral perfusion pressure in patients with brain tumors.
In 7 patients with a brain tumor and intracranial hypertension treated by ventriculosubcutaneous drainage, intracranial pressure and cerebral perfusion pressure were continuously monitored during induction of anesthesia with fentanyl 1.5 micrograms/kg, propofol 2.5 mg/kg and vecuronium 0.1 mg/kg. End-tidal pCO2 was kept constant by manual ventilation and arterial pCO2 was verified before induction and before and after intubation. Five minutes after induction the patients were intubated and measurements continued for five more minutes. ⋯ In 4 of the 7 patients an important increase to 25 (+/- 4.6) mmHg in intracranial pressure was observed during intubation. Cerebral perfusion pressure decreased from 88 (+/- 4.6) to 45 (+/- 9.8) mmHg (p less than 0.01) before intubation, but did not differ from the baseline during and after intubation. It is concluded that propofol 2.5 mg/kg in a bolus injection does not increase ICP but can produce a significant decrease of the cerebral perfusion pressure due to a marked decrease in mean arterial pressure in patients with a brain tumor.
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Acta Anaesthesiol Belg · Jan 1989
Comparative StudyComparison of intramuscular nalbuphine and nicomorphine in the treatment of post-operative pain.
Nalbuphine and nicomorphine were administered intramusculary in single doses for the relief of moderate to severe pain after abdominal surgery in a group of 40 patients to compare the analgesic effect and clinical tolerance during a 2 hour period. There was no statistically significant difference of the analgesic effect. In both groups SBP, DBP and RR decreased and HR increased significantly after injection but the tolerance of nalbuphine seems to be beter. Nalbuphine is a good choice for postoperative pain.
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We describe a case of herniation of an endotracheal tube with a high volume and low pressure cuff. In contrast with the conventional endotracheal tube with a low volume and high pressure cuff, which, after recognition of cuff herniation, can be deflated, the herniation of this type of tube could not be resolved in such a way. The large and soft cuff material had spread itself over the tube tip, as a result of the herniation and this was aggravated by deflation, making it impossible to adequately ventilate the patient. Pulse oximetry turned out to be a most helpful way of monitoring the seriousness of the situation, in which the patient was fully covered by sterile drapes.
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Acta Anaesthesiol Belg · Jan 1989
Treatment of acute nonspecific delirium with i.v. haloperidol in surgical intensive care patients.
Acute delirium may be treated by the alleviation of pain, by the restoration of specific physiological equilibria (by means of oxygen, glucose, vitamins, etc.) or by discontinuing psychotogenic medication. Acute nonspecific delirium can be treated with a specific psychopharmacological agent. ⋯ Respiratory rate, heart rate and systolic-diastolic arterial blood pressure all significantly decreased returning to normal values. No side effects were recorded.