Nagoya journal of medical science
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Randomized Controlled Trial Clinical Trial
Effect of oral clonidine premedication on hemodynamic response during sedated nasal fiberoptic intubation.
Although oral clonidine premedication is known to reduce the hemodynamic response under general anesthesia, effects of the hemodynamic response during sedated fiberoptic nasal intubation have not yet been examined. Our aim was to compare the effects of clonidine premedication on hemodynamic responses with those of atropine and hydroxyzine premedication during sedated fiberoptic nasal intubation. Thirty adult patients were randomly assigned to one of two groups: Group 1 patients (n = 15) were premedicated with atropine sulfate (0.01 mg/kg) and hydroxyzine hydrochloride (1mg/kg) intramuscularly, and group 2 patients (n = 15) were premedicated with clonidine (5 micrograms/kg) orally. ⋯ But the oral clonidine premedication (Group 2) blunted hemodynamic changes during the fiberoptic intubation. No profound hypotension or marked bradycardia was noted in group 2. We concluded that the oral clonidine premedication might contribute to hemodynamic stability during sedated fiberoptic nasal intubation.
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A clinico-neuropathological study was conducted on 60 cases of brain death, 36 males and 24 females, ranging in age from 11 to 81 years, the average being 49.4 years. Of these, 29 patients died of cerebrovascular disease. The average duration of brain death was 99 hours. ⋯ Autolysis in the cerebral cortex, thalamus, tegmentum of the brain stem, cerebellar granular layer and pituitary gland was most prominent. However, neuropathological diagnosis of underlying diseases could be made even in brain death. Histologically, the cases of brain death differed from those of cardiac arrest-induced encephalopathy and from those of long postmortem autopsy.
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One analysis of the outcome of 159 cases of head injuries was based on patients' admission Glasgow Coma Scale (GCS), score, age, CT scan findings and uniform protocol of management. Fifty-three percent of the patients were children below the age of 10 years and 70% of all patients were Saudis. ⋯ By contract, the 19.5% who had an initial GCS score of 7 or less tended to be older and had a worse prognosis (mortality 68%). A high initial GCS score, old age, associated multiple injuries and a shift of more than 4 mm of the midline structures on CT scan of the brain are useful prognostic indices in predicting the outcome of head injury.