Anaesthesia
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Propofol infusion for sedation of patients with head injury in intensive care. A preliminary report.
Propofol was given by continuous intravenous infusion to 10 patients with severe head injuries in the intensive care unit. Heart rate, mean arterial blood pressure, intracranial pressure, cerebral perfusion pressure, pupil size and arterial carbon dioxide tension were recorded throughout the study period. A mean infusion rate of 2.88 mg/kg/hour provided satisfactory sedation, and recovery from the propofol was often rapid. Cerebral perfusion pressure was significantly increased at 24 hours.
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A two-stage propofol infusion combined with fentanyl was used to maintain anaesthesia during coronary artery surgery in patients with good ventricular function. Whole blood propofol concentrations were measured at frequent intervals; plasma protein binding was measured before, during and after cardiopulmonary bypass. An initial infusion rate of 10 mg/kg/hour provided good protection from the pressor response to sternotomy. ⋯ Induced hypothermia resulted in an increase in propofol concentration which returned rapidly to the prebypass steady state value during rewarming. The free propofol fraction increased during cardiopulmonary bypass. No patient had any recall of operative events or required inotropic support during weaning from bypass.
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Pharmaseal continuous flushing devices were tested with regard to flow characteristics into simulated arterial and venous pressure systems. Two driving pressures were used and it was found that variation in driving pressure made a significant difference to the flow, while arterial or venous pressure made no significant difference. The flow devices had a wide variation although they were all of the same type. The fluid volume delivered was in the region of 100 ml in a 24-hour period.
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Comparative Study
Postdural puncture headache. A comparison between 26- and 29-gauge needles in young patients.
The incidence of postdural puncture headache after spinal anaesthesia with two types of 26- and 29-gauge needles was investigated in 149 patients less than 30 years old. Ten patients, (6.7%), six men and four women, developed typical symptoms of postdural puncture headache, while six (4.0%) developed headache of other origin. ⋯ Spinal anaesthesia in four patients (8%) was impossible to perform with the 29-gauge needle. By using the latter, spinal anaesthesia can be given to young adults with little risk of postdural puncture headache.