Articles: general-anesthesia.
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Klinische Wochenschrift · Nov 1984
Randomized Controlled Trial Comparative Study Clinical TrialAdrenocortical suppression by a single induction dose of etomidate.
In a prospective controlled trial we studied the effect of a single induction dose of etomidate or thiopentone on the adrenocortical function in 29 patients undergoing elective surgery. During anesthesia and in the recovery period serum cortisol rose significantly in the thiopentone group only. ⋯ Moreover, plasma ACTH increased significantly more after etomidate than after thiopentone (p less than 0.02) indicating relative unresponsiveness of the adrenal cortex to stimulation by endogenous ACTH. We conclude that a single i.v. bolus of etomidate (0.26 mg/kg) leads to significant adrenal insufficiency in patients without preexisting endocrine abnormalities.
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In nine patients, with preoperative ICP monitoring, anaesthesia was induced with thiopentone 5 mg kg-1 given over 1 min, followed by pancuronium 0.1 mg kg-1. After manual hyperventilation with nitrous oxide and oxygen for 3 min they were given thiopentone 2.5 mg kg-1 over 30 s (phase 1); 30 s later laryngoscopy was performed and topical analgesia administered to the larynx. Endotracheal intubation was performed 1 min after spraying the cords (phase 2). ⋯ Although there was a significant decrease (P less than 0.05) in MAP at the end of the second dose of thiopentone, there were no other significant changes in ICP, MAP or PaCO2 throughout the study. In two patients there were transient decreases in cerebral perfusion pressure to less than 60 mm Hg. Although MAP increased in five of the patients during laryngoscopy and intubation, there was no increase in ICP, showing that the MAP was still within the autoregulatory limits.
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Anaesth Intensive Care · Nov 1984
The influence on foetal outcome of maternal carbon dioxide tension at caesarean section under general anaesthesia.
The influence on foetal outcome of maternal PCO2 at caesarean section under general anaesthesia was assessed in 27 "clinically acceptable ideal patients" as defined by Crawford. A standard anaesthetic technique was employed which utilised left lateral tilt and an F1O2 of 0.5. ⋯ No relationship was found between clinically measured parameters of foetal outcome and maternal end-tidal PCO2. The relevant literature is reviewed.
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J Bone Joint Surg Br · Nov 1984
Case ReportsIntra-operative awakening to monitor spinal cord function during scoliosis surgery. Description of the technique and report of four cases.
We used a modification of the wake-up test to monitor spinal cord function in 102 consecutive scoliotic patients undergoing Harrington instrumentation. Four patients were found to have a neural deficit when they were awakened during the operation. ⋯ Using our method, we have encountered no problem in performing the wake-up test, although attention is drawn to the difficulty in repeating the test if the patient is re-anaesthetised with diazepam. There were no false negative results in this series.