British journal of anaesthesia
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Clinical Trial
Do fluid administration and reduction in norepinephrine dose improve global and splanchnic haemodynamics?
We studied global and splanchnic haemodynamics in patients with septic shock, while reducing norepinephrine doses by progressive fluid loading administration. Ten patients (six female, four male, aged 39-86 yr, mean 61 yr) were assessed using a transpulmonary thermo-dye dilution technique to measure cardiac output, intrathoracic blood volume and total blood volume. Splanchnic blood flow was measured by the steady state indocyanine green technique using a hepatic venous catheter. ⋯ Gastric mucosal (PRCO2) increased from 7.5 (2.5) to 9.0 (2.8) kPa. The PCO2 gap, i.e. the difference between regional and end-tidal PCO2, increased from 3.1 (2.5) to 4.0 (2.9) kPa. Marked individual variation in responses suggests that norepinephrine dose reduction by fluid loading in patients with stabilized septic shock does not necessarily increase global or splanchnic blood flow.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ketamine and morphine for analgesia after tonsillectomy in children.
In a double blind study we compared the effects of i.m. ketamine with morphine on postoperative analgesia in children undergoing tonsillectomy. Eighty children (aged 6-15 yr) were randomized to receive either i.m. morphine 0.1-0.15 mg kg-1 or ketamine 0.5-0.6 mg kg-1, after induction of a standard general anaesthetic. ⋯ There were no differences in supplemental analgesia requirements, or the incidence of vomiting or dreaming between the groups. We conclude that ketamine 0.5 mg kg-1 i.m. may be an alternative analgesic for children undergoing tonsillectomy.
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Case Reports
Successful resuscitation from recurrent ventricular fibrillation secondary to butane inhalation.
Resuscitation from cardiac arrest caused by volatile substance abuse is rarely successful. Large doses of catecholamines given during resuscitation, in the presence of butane, may cause recurrent ventricular fibrillation. ⋯ Cardiac output was restored 10 min after the administration of intravenous amiodarone. We suggest that antiarrhythmic agents should be used early during resuscitation to prevent recurrent arrhythmias.
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Clinical Trial
Intravenous clonidine infusion in critically ill children: dose-dependent sedative effects and cardiovascular stability.
Clonidine is used for analgesia and sedation in paediatric anaesthesia, but there are no data on its sedative properties and side effects in critically ill children. We studied 30 ventilated children aged 10 yr and under to determine an effective i.v. dosing range and to assess its cardiovascular effects. Twenty non-paralysed, ventilated children were given a background infusion of midazolam 50 micrograms kg-1 h-1 combined with a variable clonidine infusion (0.1-2 micrograms kg-1 h-1) to maintain optimal sedation. ⋯ Dose-dependent sedation was achievable (713 out of 861 h) without cardiovascular side effects, but an infusion limit of clonidine 1 microgram kg-1 h-1 was inadequate in two patients. An increased dose limit of 2 micrograms kg-1 h-1 combined with midazolam 50 micrograms kg-1 h-1 achieved satisfactory sedation scores for 602 out of a total of 672 h studied with no failures. Clonidine in combination with midazolam at 1 microgram kg-1 h-1 was not associated with significant changes in heart rate arterial pressure or cardiac index.
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We measured the haemodynamic effects of changing from the supine position to the lateral decubitus (lateral) position, and then to the kidney rest lateral decubitus (kidney) position in 12 patients undergoing nephrectomy under isoflurane anaesthesia. Eight control patients undergoing pulmonary surgery remained in the lateral position. The lateral position produced no significant changes. ⋯ There were also significant reductions in cardiac index (from 3.04 (SD 0.21) to 2.44 (0.26) litre min-1 m-2, P < 0.01) and stroke volume index (from 40 (5) to 31 (5) ml beat-1 m-2, P < 0.01). The systemic vascular resistance index increased significantly (P < 0.05). Cardiac output was probably reduced by a decrease in venous return and an increase in systemic vascular resistance.