Anaesthesia
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Comparative Study
Bladder temperature as an estimate of body temperature during cardiopulmonary bypass.
Bladder temperature measured by a thermistor-tipped urinary catheter, was compared to oesophageal, nasopharyngeal, rectal and cutaneous temperatures in 33 patients during cardiopulmonary bypass. The bladder site was warmer than all other monitored sites in the pre-bypass period and showed least variation in temperature. The rate of change of bladder temperature during cooling and rewarming on bypass was significantly (p less than 0.01) lower than for oesophageal and nasopharyngeal temperatures, but was greater than or similar to the rate of change of rectal and cutaneous temperatures. This method of temperature measurement was found to be satisfactory during major surgery and also during the postoperative period in the intensive care unit.
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Cerebral blood flow, cerebral oxygen consumption, lactate and glucose metabolism were measured in 13 patients during anaesthesia with nitrous oxide, oxygen and enflurane 0.5% and after 30 minutes infusion of propofol. The mean blood concentration of propofol was 4.06 micrograms/ml. ⋯ Cerebral oxygen consumption decreased by 18.25%. Changes in the electro-encephalograph were related to the blood levels of propofol.
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The effects of a bolus injection of propofol on mean intracranial pressure were studied in six adult, comatose patients who had severe head injuries. Propofol 2 mg/kg was given intravenously over 90 seconds when the mean intracranial pressure reached or exceeded 25 mmHg. Arterial blood gas values, heart rate and central venous pressure remained stable at all measurements. ⋯ The mean (SEM) intracranial pressure decreased statistically significantly (p less than 0.05) at 30 seconds and at 1 and 2 minutes, from 25 (3) to 11 (4) mmHg. The cerebral perfusion pressure decreased statistically significantly from 92 (8) mmHg at all measurements (p less than 0.05). The lowest value at 3 minutes was 50 (7) mmHg but in four patients at that time the perfusion pressure was below 50 mmHg.
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A 30-year-old woman developed severe chest pain while out shopping and was admitted to the delivery suite. She was 38 weeks pregnant with her second child. ⋯ She went into spontaneous labour 30 hours later and was delivered vaginally. This report reviews myocardial infarction in pregnancy and considers the clinical management of this patient.
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The effects of propofol on cerebrospinal fluid pressure, mean arterial pressure, cerebral perfusion pressure and heart rate were studied during induction, tracheal intubation and skin incision in 23 patients scheduled for elective craniotomy. Premedication consisted of midazolam 0.1 mg/kg intramuscularly and metoprolol 1 mg/kg orally. Measurements were made or derived at time zero and 0.5, 1, 1.5, 2 and 3 minutes after an induction dose of propofol 1.5 mg/kg. ⋯ Heart rate did not change. Propofol combined with moderate dose of fentanyl, obtunded the usual cerebrospinal fluid and arterial pressure responses to intubation and other noxious stimuli. Thus propofol seems to be a suitable intravenous anaesthetic agent for induction and maintenance in neuroanaesthesia.