British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effects of hydrocortisone and adrenaline on natural killer cell activity.
We have studied the effects of hydrocortisone and adrenaline on natural killer (NK) cell activity and on the distribution of circulating lymphocyte subpopulations in 30 patients undergoing elective partial laminectomy under general anaesthesia. The patients were allocated to receive adrenaline (group 1, n = 11), hydrocortisone and adrenaline (group 2, n = 11) or neither hydrocortisone nor adrenaline (group 3, n = 8). Group 1 and group 2 patients received local adrenaline infiltration during operation to reduce bleeding. ⋯ In groups 1 and 3, the CD4/CD8 cell ratio did not change significantly during operation. However, compared with groups 1 and 3, group 2 showed a significantly reduced CD4/CD8 cell ratio during operation. Therefore, these results suggest that even in cases of such severe stress that the immune response was depressed by increased serum cortisol concentrations, adrenaline-induced NK cell activity enhancement was preserved.
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We have measured haemodynamic responses to induction of anaesthesia, laryngoscopy and intubation in 103 mild-moderate hypertensive patients (83 patients (diastolic pressures < or = 110 mm Hg) currently receiving one of four monotherapies (ACE inhibitors, group A; beta adrenoceptor blocking drugs, group B; calcium channel antagonists, group C; diuretics, group D) and 24 were untreated hypertensive patients). Anaesthesia was induced with fentanyl 1.5-2.0 micrograms kg-1 and thiopentone 3-5 mg kg-1. Tracheal intubation was facilitated by vecuronium 0.1 mg kg-1 and anaesthesia maintained with enflurane and nitrous oxide in oxygen. ⋯ CO was unaltered. Similar changes occurred in the untreated hypertensive patients, although nine of 24 patients exhibited HR > or = 100 beat min-1 after laryngoscopy and intubation. Comparison of the changes in SAP, DAP, CO and SVR with time showed no differences in the five treatment groups; changes in HR were significantly less in group B compared with the other groups (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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We have evaluated in 10 anaesthetized patients the time course of action, infusion requirements, reversibility and pharmacokinetics of Org 9487. Org 9487 was administered as a bolus dose of 1.5 mg kg-1, followed by an infusion to maintain a block of 75-85% for 60 min. After recovery from the bolus dose, a mean dose of Org 9487 3.4 (SD 1.0) mg kg-1 h-1 was administered to maintain a mean neuromuscular block of 83 (3)%. ⋯ The concentration of the 3-OH metabolite remained relatively low. Urinary excretion of Org 9487 and its metabolites was 22% in 24 h. In conclusion, a 1-h infusion of the short-acting drug Org 9487 changed its time course characteristics gradually from that of a short-acting neuromuscular blocking agent to that of a neuromuscular blocker with an intermediate duration of action.