Articles: anesthetics.
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Acta Anaesthesiol Scand · Jul 1985
Comparative StudyEtomidate infusion and adrenocortical function. A study in elective surgery.
The adrenocortical response to a short tetracosactrin (Synacthen) test was studied in 11 patients receiving either etomidate infusion or thiopentone infusion used to maintain anaesthesia for abdominal hysterectomy. Pethidine was used as the narcotic component. ⋯ No suppression was found in patients receiving thiopentone infusion. It is concluded that etomidate cannot be recommended for routine induction and maintenance of anaesthesia.
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Acta Anaesthesiol Scand · Jul 1985
Etomidate anesthesia inhibits the cortisol response to surgical stress.
Plasma cortisol was measured in 18 patients undergoing gynecological procedures under etomidate or methohexital and nitrous oxide anesthesia. Plasma ACTH was also measured in three patients in each group. The mean plasma cortisol concentration before anesthesia was comparable in both groups. ⋯ The increase in plasma ACTH was equivalent in the two groups. Therefore, etomidate is a potent inhibitor of the adrenal response to surgery. The absence of clinical consequences associated with the blunted response suggests that a major increase in adrenal hormone production may not be necessary during surgery.
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Comparative Study
Neuromuscular effects of atracurium during halothane-nitrous oxide and enflurane-nitrous oxide anesthesia in humans.
To compare the effect of halothane and enflurane on an atracurium-induced neuromuscular blockade, the authors studied 40 patients during elective surgery. During 1.25 MAC enflurane-nitrous oxide (n = 20) or halothane-nitrous oxide (n = 20) (MAC value includes contribution from 60% nitrous oxide), the doses depressing twitch tension 50% (ED50S) for atracurium were 70 and 77 micrograms/kg, respectively. The difference was not significant. ⋯ The authors conclude that the potency of atracurium does not differ during halothane-nitrous oxide and enflurane-nitrous oxide anesthesia. Combining the results of this study with a previous study (atracurium ED50 = 68 micrograms/kg and 83 micrograms/kg during isoflurane-nitrous oxide and fentanyl-nitrous oxide anesthesia respectively), the potency of atracurium does not differ by more than 20% among the four anesthetic techniques studied. The background anesthetic appears to have less effect on an atracurium-induced neuromuscular blockade than on one produced by other longer-acting nondepolarizing muscle relaxants (e.g., pancuronium and d-tubocurarine).
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Allergic reactions to the intravenous drugs used in anaesthesia pose a major problem for the anaesthetist, since they represent an unpredictable and occasionally life-threatening event. Reports of 2 such cases are presented, and the incidence, assessment and prophylaxis of such reactions are discussed.