Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intubation following propofol and alfentanil with intubation following thiopentone and suxamethonium.
We have compared a rapid sequence induction of anaesthesia using propofol 2 mg.kg-1 and alfentanil 50 micrograms.kg-1, with a standard technique using thiopentone 5 mg.kg-1 and suxamethonium 1 mg.kg-1. The incidence of complications, and the quality of conditions for intubation, were similar in both groups. The patients receiving propofol and alfentanil showed a significant decrease in blood pressure and heart rate following induction (p < 0.01), whereas the group receiving thiopentone and suxamethonium showed a significant increase in blood pressure and heart rate following induction (p < 0.01). The use of propofol and alfentanil provided a satisfactory alternative to thiopentone and suxamethonium for a rapid sequence induction of anaesthesia.
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We questioned 50 anaesthetic staff about the costs of consumables used in routine anaesthetic practice. By means of a questionnaire staff were asked for estimates of the cost of 28 drugs, fluids and disposables. The responses were more accurate than in previous surveys; 47% of all the estimated costs were within 50% of the actual costs and 75% were within 100%. ⋯ However, allowing for inflation, the cost today is actually equivalent to the cost in 1959. Since 1980 there has been no consistent pattern in drug prices, with some prices remaining the same, others falling and some increasing; all are, however, cheaper in real terms. It is possible to make substantial savings by using the more expensive drugs judiciously and by encouraging the use of low-flow, closed-circuit anaesthetic systems.
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A 52-year-old Caucasian male underwent heterotopic cardiac transplant and subsequently developed a ventricular tachycardia in his native heart. The arrhythmia was successfully treated by cardioversion, despite an increased rate associated with induction of anaesthesia with propofol. The method of synchronised cardioversion is described and a possible hypothesis for the acceleration of ventricular tachycardia following induction is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural infusions for nulliparous women in labour. A randomised double-blind comparison of fentanyl/bupivacaine and sufentanil/bupivacaine.
Sixty nulliparous women received epidural infusions in labour of 0.0625% bupivacaine containing either 2.5 micrograms.ml-1 of fentanyl or 0.25 micrograms.ml-1 of sufentanil, each starting at 12 ml.h-1. The duration of each stage of labour did not differ significantly between the groups nor did the mode of delivery. The quality of analgesia in the first and second stages of labour and at delivery was similar in the two groups and there were no significant differences in the bupivacaine dose requirements. ⋯ There were no significant differences in Apgar scores, umbilical cord blood pH levels or neurologic and adaptive capacity scores at 2 or 24 h. Satisfaction with first and second stage analgesia was high with no differences between the groups. There were no significant differences in the incidence of postnatal symptoms with 52% of women reporting perineal pain and 45% localised backache.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between mivacurium and suxamethonium in children.
The neuromuscular effects of mivacurium were compared with those of suxamethonium in 69 children (aged 2-12 years), during nitrous oxide, oxygen and halothane anaesthesia in a randomised open study. Neuromuscular block was monitored by measuring the acceleration of the thumb caused by contraction of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve at the wrist using an Accelograph. End-tidal carbon dioxide was maintained at about 4 kPa in both groups. ⋯ The range of maximum block was similar for both drugs. The average time to reach maximum block was 143 s for mivacurium and 56 s for suxamethonium. Intubating conditions were similar in the two groups.