Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic and plasma catecholamine responses during total intravenous anaesthesia for laryngomicroscopy. Thiopentone compared with propofol.
We compared the haemodynamic responses to endolaryngeal procedures during anaesthesia with propofol or thiopentone. Two minutes after administration of glycopyrronium 4 micrograms.kg-1 and alfentanil 17.5 micrograms.kg-1 anaesthesia was induced with either propofol 2.0 mg.kg-1 (n = 8) or thiopentone 5.0 mg.kg-1.min-1, respectively. Muscle relaxation was induced and maintained with suxamethonium. ⋯ With propofol, plasma adrenaline concentrations decreased significantly after induction and remained below baseline values throughout the procedure. After insertion of the operating laryngoscope the haemodynamic response was more pronounced with thiopentone than with propofol. Propofol blocks the catecholamine and haemodynamic responses to endolaryngeal procedures more effectively than thiopentone.
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Six patients undergoing paravertebral blocks for chronically painful conditions of the chest wall were thermographically imaged so that the extent of cutaneous vasodilatation and hence sympathetic block could be correlated with the distribution of the somatic block. All blocks were performed by a single experienced operator, with a single percutaneous entry, using 15 ml of 0.5% bupivacaine at a mean level of T9-10 (range T7-8--T10-11), with radiological confirmation of correct needle placement. There was a mean distribution of the somatic block of five dermatomes (range 1-8), as evidenced by loss of pinprick sensation, with upper and lower limits of T6 and L3. ⋯ No significant postural changes in blood pressures were seen, although there was a small but significant decrease in supine heart rate (p = 0.05). This study demonstrates that a large unilateral somatic and sympathetic block is obtainable with a single thoracic percutaneous paravertebral injection. It challenges the suggestions that this method of analgesia is ineffective and hazardous, that a sympathetic component is a rare accompaniment and that the lumbar nerve roots are spared.
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Six hundred and ninety-four members of the Intensive Care Society working in the UK were surveyed by postal questionnaire between May and November 1993 to determine their management of convulsive status epilepticus resistant to initial therapy with intravenous diazepam and phenytoin. Four hundred and eight forms were completed and returned (58.8%). The survey revealed that, following failure of initial management, a benzodiazepine infusion (35%) or anaesthetic induction agent (32%) were the preferred second lines of treatment in intensive care units. ⋯ Patients were usually monitored using clinical assessment only (45%), except in paediatric intensive care units and specialist neurological or neurosurgical units where the majority used a cerebral function monitor. Only 12% of the respondents were aware of a protocol for status epilepticus in their intensive care units. The most frequently used therapeutic and monitoring strategies in the management of refractory status epilepticus in the UK are insufficient and need re-evaluation.
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Biography Historical Article Classical Article
The Woolley and Roe case. 1954.