British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Plasma propofol concentration and EEG burst suppression ratio during normothermic cardiopulmonary bypass.
During cardiopulmonary bypass (CPB), several factors affect drug disposition and action. This topic has not been studied extensively during normothermic CPB. In this study, we related propofol dose to plasma propofol concentration and burst suppression of the EEG during normothermic bypass. ⋯ The pharmacokinetics and pharmacodynamics of propofol change during normothermic CPB. During normothermic CPB, the efficacy of propofol may be enhanced compared with before CPB.
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Case Reports
Anaesthetic management of a parturient with pulmonary stenosis and aortic incompetence for Caesarean section.
Anaesthetic management of Caesarean section in a parturient with severe pulmonary stenosis and aortic regurgitation is described. The valvular sequelae resulted from previous unsuccessful surgical correction (Ross procedure) of congenital aortic stenosis. This case demonstrates the importance of multi-disciplinary assessment and careful anaesthetic planning, to avoid deterioration in perioperative cardiac performance in parturients with complex valvular disease.
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There is an increasing trend towards performing craniotomy awake. The challenge for the anaesthetist is to provide adequate analgesia and sedation, haemodynamic stability, and a safe airway, with an awake, cooperative patient for neurological testing. ⋯ We have developed a technique for craniotomy, which facilitates awake neurological testing, is safe, and has good patient satisfaction.
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We present a case of neurogenic pulmonary oedema (NPO) due to subarachnoid haemorrhage that resulted in hypoxia refractory to conventional mechanical ventilation. Prone positioning was employed, resulting in rapid and sustained improvement in oxygenation. ⋯ Prone ventilation may be of value in the management of NPO, both in treating life-threatening hypoxia and in optimizing neurological recovery. Further data are required on its effect on intracranial pressure after subarachnoid haemorrhage.
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Many anaesthetists are deterred from using total i.v. anaesthesia because of uncertainty over the concentration of propofol required to prevent awareness. We predicted blood and effect-site concentrations of propofol at two clinical end-points: loss of consciousness and no response to a painful stimulus. ⋯ Unconsciousness and lack of response to a painful stimulus occur within a defined range of effect-site concentrations, predicted by Diprifusor TCI software.