British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of methohexitone and propofol with or without alfentanil on seizure duration and recovery in electroconvulsive therapy.
We have studied the effects of methohexitone and propofol with and without alfentanil on seizure duration and recovery in this observer-blinded, prospective, randomized, crossover study involving 24 patients undergoing electroconvulsive therapy (ECT). Each patient had four treatment sessions, and received the following four i.v. regimens in random order: methohexitone 0.75 mg kg-1, methohexitone 0.50 mg kg-1 and alfentanil 10 micrograms kg-1, propofol 0.75 mg kg-1, propofol 0.50 mg kg-1 and alfentanil 10 micrograms kg-1. Additional methohexitone or propofol was given as needed in 10-20-mg increments until loss of consciousness. ⋯ Recovery time was statistically shorter in patients receiving propofol compared with methohexitone-alfentanil and methohexitone alone. Alfentanil with a reduced dose of methohexitone or propofol provided unconsciousness and increased seizure duration in patients undergoing ECT. We conclude that the combination of methohexitone with alfentanil is a good regimen for ECT, especially for patients with short seizure duration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Heat retention using passive systems during anaesthesia: comparison of two plastic wraps, one with reflective properties.
Hypothermia during prolonged surgery may be prevented by active and passive warming methods. We have compared randomly two types of occlusive body wraps in groups of 20 patients. One wrap had additional reflective properties which, by reducing radiative in addition to convective and evaporative heat loss, was expected to improve heat conservation. ⋯ Skin and core body temperatures increased and core temperature exceeded 37 degrees C in 40% of patients in both groups. This continuous increase in temperature was unexpected and the observed heat gain may have been stimulated endogenously by the type of surgery rather than that supplied externally. Overall, mean hourly heat gain was similar in both groups: 71 (SD 28) kJ h-1 in the reflective group and 67 (33) kJ h-1 in the other group.
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Randomized Controlled Trial Clinical Trial
Partly exhausted soda lime or soda lime with water added, inhibits the increase in compound A concentration in the circle system during low-flow sevoflurane anaesthesia.
We performed low-flow sevoflurane anaesthesia at a flow rate of 1 litre min-1 in three groups (n = 8 each) using 600 g of fresh soda lime (control group), 600 g of soda lime with 60 ml of water added (water group) or 600 g of soda lime saturated with carbon dioxide, that is partly exhausted soda lime (carbon dioxide group). Degradation products in the system were measured hourly. ⋯ The mean maximum concentration of compound A was significantly higher in the control group (mean 16.0 (SD 5.0) ppm) than in the water (1.4 (1.0) ppm) or carbon dioxide (4.0 (1.8) ppm) group, and the maximum temperature of the soda lime was significantly lower in the carbon dioxide group (30.7 (3.5) degrees C) than in the control (43.4 (1.8) degrees C) or water (40.8 (1.8) degrees C) group (P < 0.05). The use of partly exhausted soda lime or soda lime with water added reduced compound A concentrations in the system during low-flow sevoflurane anaesthesia.
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Randomized Controlled Trial Clinical Trial
Prevention of hypothermia by cutaneous warming with new electric blankets during abdominal surgery.
We have evaluated the efficacy of new electric warming blankets, which meet the requirements of the international standard for perioperative electrical and thermal safety, in preventing intraoperative hypothermia. We studied 18 patients undergoing abdominal surgery, allocated to one of two groups: in the control group, there was no prevention of intraoperative hypothermia (n = 8) and in the electric blanket group, two electric blankets covered the legs and upper body (n = 10). ⋯ Five patients shivered in the control group compared with one in the electric blanket group (P < 0.05). We conclude that cutaneous warming with electric blankets was an effective means of preventing intraoperative hypothermia during prolonged abdominal surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Skin vasomotor reflex induced by laryngoscopy: comparison of the McCoy and Macintosh blades.
We studied 22 female patients (ASA I or II) to investigate if laryngoscopy and intubation induced the skin vasomotor reflex (SVmR), and to compare the effects of the McCoy and Macintosh blades on the SVmR. Anaesthesia was induced with fentanyl, midazolam, vecuronium and nitrous oxide. In 11 patients, the vocal cords were seen for 3 s with the McCoy blade. ⋯ In the other 11 patients, the first and second laryngoscopies, respectively, were performed with the Macintosh and McCoy blades. Laryngoscopy alone and intubation with laryngoscopy significantly reduced skin blood flow in the ring finger of all patients (P < 0.01), indicating that both procedures provoked the SVmR. The magnitude of the SVmR and haemodynamic changes did not differ significantly between the two groups.