British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of coagulation and blood loss during anaesthesia with inhaled isoflurane or intravenous propofol.
Propofol has been reported to affect blood coagulation. This prospective, randomized study compared coagulation and blood loss during anaesthetic maintenance with target-controlled intravenous propofol infusion vs. inhaled isoflurane. Thirty-eight ASA I-III patients undergoing head and neck surgery were allocated randomly to receive either inhaled isoflurane at end-tidal concentration 1-1.5% (group I, n=20) or target-controlled infusion (TCI) of propofol at target concentration 2-5 microg ml(-1) (group P, n=18). ⋯ Total blood loss was also not significantly different (median group I: 350 ml, range 20-1200 ml; group P: 200 ml, range 50-800 ml). Shortening of R-time and widening of angle developed over time in both groups (P<0.05 groups I and P, repeated measures ANOVA). We conclude that maintenance of anaesthesia with propofol TCI at 2-5 microg ml(-1) does not cause detectable coagulation changes on thrombelastography nor increase surgical blood loss when compared to inhaled isoflurane.
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Case Reports
Use of remifentanil in a patient with peripartum cardiomyopathy requiring Caesarean section.
We describe a case of a 26 yr old primigravida at 39 weeks' gestation, with a diagnosis of peripartum cardiomyopathy, requiring urgent Caesarean section. The patient presented in severe heart failure and active labour. A general anaesthetic, using a target-controlled infusion of propofol and an intravenous infusion of remifentanil, was used to provide stable anaesthesia and analgesia for a successful delivery. The unusual diagnosis of peripartum cardiomyopathy and the potential benefits of the use of remifentanil in high-risk obstetric surgery are discussed.
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Randomized Controlled Trial Clinical Trial
Effects of different concentrations of sevoflurane and desflurane on subcortical somatosensory evoked responses in anaesthetized, non-stimulated patients.
Twenty-four patients were recruited and given either sevoflurane or desflurane as their sole anaesthetic. Each patient was given sequentially increasing or decreasing doses at 0.5 MAC intervals, and the median nerve somatosensory evoked response recorded after an equilibration at each concentration. The N20-P25 and P25-N35 amplitudes decreased with increasing agent concentration. ⋯ The peak inflection points were at 3.2% for sevoflurane and 4.9% for desflurane. There were no differences between the ascending and descending groups. This increase in activity in the midbrain at 'surgical' end-tidal anaesthetic concentrations suggests more complex neuroelectrical responses to anaesthesia than simple global suppression.
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I report two patients undergoing open heart surgery, with nitrous oxide and isoflurane anaesthesia, for whom bispectral index (BIS) monitoring showed high BIS values with nitrous oxide and isoflurane anaesthesia. The BIS decreased immediately after nitrous oxide was stopped and increased again after nitrous oxide was restarted.
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Case Reports
Successful epidural anaesthesia for Caesarean section in a patient with spondyloepiphyseal dysplasia.
Spondyloepiphyseal dysplasia congenita is a rare genetic entity in which it is very important to involve anaesthetists early on to discuss the possible anaesthetic complications for both general or regional anaesthesia. A case is described of a patient with spondyloepiphyseal dysplasia and multifetal pregnancy in which successful epidural anaesthesia for caesarean section was performed.