Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Isoflurane and propofol for long-term sedation in the intensive care unit. A crossover study.
Propofol and isoflurane have been reported recently to offer better sedation than alternative agents in patients who require long-term ventilation in the Intensive Care Unit. This is the first report of a direct comparison between propofol and isoflurane. ⋯ Few adverse events were noted. Technological advances in the administration of volatile agents as long-term sedatives in the Intensive Care Unit may facilitate their more widespread use.
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Comparative Study
Catecholamine response to laryngoscopy and intubation. The influence of three different drug combinations commonly used for induction of anaesthesia.
The haemodynamic response and changes in plasma catecholamine concentrations associated with laryngoscopy and tracheal intubation were compared during anaesthesia employing three strictly standardised techniques with commonly used drug combinations. Thirty-six patients were investigated consecutively resulting in 12 patients in each of three study groups. Anaesthesia was induced with thiopentone 5 mg.kg-1 (group 1), fentanyl 6 micrograms.kg-1 with thiopentone 5 mg.kg-1 (group 2), or midazolam 0.2 mg.kg-1 with fentanyl 6 micrograms.kg-1 (group 3). ⋯ Noradrenaline concentration increased by a maximum of 147%. The addition of fentanyl (groups 2 and 3) attenuated the adverse haemodynamic response and elevation of plasma catecholamine concentrations; heart rate and mean arterial pressure did not differ from pre-intubation values and plasma catecholamine concentrations decreased steadily. Substitution of thiopentone by midazolam in combination with fentanyl abolished the adverse haemodynamic response and modified the increase in plasma catecholamine concentrations. 'High-dose' opioid anaesthesia is not necessary to produce optimal conditions during laryngoscopy and intubation.
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The experience of Advanced Trauma Life Support training received by three anaesthetists is discussed with particular reference to the teaching of airway management, the grade of staff who should attend the present courses and the relevance to the British hospital system. We conclude that these courses are useful but limited by their inflexibility and failure to recognise the difference in skill mix in the British setting.
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In 1985 and 1990 postal questionnaires were sent to anaesthetic senior registrars in training in the United Kingdom to determine the extent of higher specialist training in chronic pain management. There were wide variations in training and experience amongst senior registrars. Overall there was little change between 1985 and 1990. In particular the number of anaesthetic senior registrars who felt equipped to undertake a consultant post with an interest in chronic pain management had not increased.
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One hundred and thirty-two patients staying in hospital more than 24 h were visited pre- and postoperatively. Patients were asked a standard set of questions, and 39% could not remember accurately what they were asked. ⋯ In 15% of patients, information that significantly altered subsequent anaesthetic management was discovered, but in less than 3% would ignorance of the patient's condition have required postponement of the surgery. We conclude that the major reason for a pre-operative visit by an anaesthetist is that patients appreciate it, rather than it being medically necessary.