British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly.
In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). ⋯ A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.
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Randomized Controlled Trial Clinical Trial
Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium.
Atracurium-induced intense neuromuscular blockade was evaluated in 60 randomly selected patients using the post-tetanic count (PTC) and train-of-four (TOF) methods. Thirty patients were anaesthetized with thiopentone, nitrous oxide and halothane, and 30 patients received thiopentone, nitrous oxide and fentanyl. In all patients, the response to post-tetanic single twitch stimulation appeared before the response to TOF stimulation, and a close correlation was found between the number of post-tetanic twitches (PTC) and the time interval between the PTC and the first detectable TOF response. ⋯ A PTC of 1 meant that the TOF response would appear in, on average, 9 min (95% confidence limits: 4-14 min). Halothane significantly prolonged the time from injection of atracurium to the first response to post-tetanic single twitch stimulation. It is concluded that the relationship between PTC and the time to first response to TOF nerve stimulation makes the PTC method a valuable supplement to TOF nerve stimulation for neuromuscular monitoring during clinical anaesthesia involving atracurium.
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Malignant hyperpyrexia developed, and was successfully treated, in a 50-year old man undergoing pyelolithotomy. Early diagnosis with the assistance of end-tidal carbon dioxide monitoring facilitated prompt treatment with i.v. dantrolene. A positive muscle biopsy subsequently confirmed the diagnosis. The only likely triggering agent used was isoflurane.
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Biography Historical Article
A British footnote to the life of Horace Wells.
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Comparative Study
Haemodynamic effects of a prolonged infusion of propofol as a supplement to nitrous oxide anaesthesia. Studies in association with peripheral arterial surgery.
The haemodynamic effects of propofol at two infusion rates (54-65 and 108-130 micrograms kg-1 min-1) have been studied during peripheral arterial surgery in eight elderly patients premedicated with morphine sulphate 0.15 mg kg-1. The haemodynamic response to laryngoscopy and intubation was partially suppressed: neither arterial pressure nor heart rate exceeded awake values. ⋯ During surgery, with either spontaneous (SV) or intermittent positive pressure (IPPV) ventilation, both infusion rates were associated with decreases in arterial pressures when compared with the awake state. Cardiac output was decreased (SV: -35%, IPPV: -36%) and SVR increased (SV: +22%, IPPV: +45%) at the lower infusion rate; similar changes were observed during the faster infusion rate.