Articles: general-anesthesia.
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Total intravenous anaesthesia is a feasible alternative to the use of inhalational agents and the rationale behind such a technique is presented. The various intravenous agents are discussed, particularly with regard to their suitability for this form of anaesthesia, and their physiological effects compared with those of the inhalational anaesthetics. Some of the problems associated with the use of total intravenous anaesthesia are mentioned.
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Inaccuracy of oesophageal pressure for pleural pressure estimation in supine anaesthetized subjects.
Oesophageal pressure was measured, using a balloon and catheter system, at three or four positions in the oesophagus of eight supine subjects anaesthetized with 1-1.5% halothane in 67% nitrous oxide. Airway pressure and the difference between airway and oesophageal pressures were recorded during occlusion of inspiration, occlusion of expiration and occlusion of expiration followed by inspiratory occlusion. ⋯ The change in oesophageal pressure was expressed as a fraction of the change in airway pressure: the maximum fraction was obtained in each patient, and the mean of these maximum values was 82%. This suggests that changes in the difference between airway and oesophageal pressures will overestimate the change in transpulmonary pressure during artificial ventilation in supine subjects, and that lung compliance would be underestimated.
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In six patients undergoing gynaecological surgery computer assisted total intravenous anaesthesia (CATIA) was performed using etomidate and alfentanil. Constant plasma levels of etomidate (0.3 microgram/ml) from the very beginning onwards were achieved using the so called B. ⋯ Alfentanil plasma concentrations of 0.45 microgram/ml were maintained by the same infusion scheme beginning with skin incision until 20 minutes prior to the end of surgery. The proposed concept of CATIA provided an adequate analgesic and hypnotic effect during anaesthesia for abdominal surgery with a recovery period of short duration.
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Etomidate has been studied in two groups of patients. In Group 1, 50 patients received etomidate 100 micrograms/kg/minute with fentanyl and a muscle relaxant, ventilation being with air and oxygen (50%). The technique gave a smooth, pleasant induction with all patients asleep within 2 minutes. ⋯ The cardiovascular system remained stable in all patients. Mean recovery time was 16.1 minutes (range 3-38 minutes). Twitching and restlessness were the main complications during recovery.