Articles: anesthetics.
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Comparative Study
Infusions of propofol to supplement nitrous oxide-oxygen for the maintenance of anaesthesia. A comparison with halothane.
The peri-operative and postoperative effects of propofol given by infusion were compared with halothane as a supplement to nitrous oxide-oxygen anaesthesia for body surface surgery in patients who breathed spontaneously. Anaesthesia was induced after opioid premedication, with either propofol 2.5 mg/kg or thiopentone 4-5 mg/kg which were followed respectively by an infusion of propofol 12 mg/kg/hour for 10 minutes and at a variable rate thereafter, or by halothane at a mean inspired concentration of 1.2%. ⋯ The cardiovascular effects during induction and maintenance of anaesthesia were similar in the two groups. The overall incidence of side effects was low but immediate recovery was significantly faster in patients who received propofol.
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery times and side effects after propofol infusion and after isoflurane during ear surgery with additional infiltration anaesthesia.
Two anaesthetic procedures that did not include nitrous oxide were compared in a randomised study of 50 patients for tympanoplasty and tympanoscopy: propofol given for induction and maintenance, and thiopentone-isoflurane given for induction and maintenance, respectively. Induction in the first group was with a bolus injection of propofol and the same agent was given for the duration of anaesthesia by continuous intravenous administration. Thiopentone was given until loss of the eyelash reflex and anaesthesia maintained with isoflurane 0.4-2.0%. ⋯ The two patient groups were analysed for age, sex and weight as well as for side effects during the induction, maintenance and recovery periods, such as coughing, vomiting, venous pain, spontaneous movements, singultus, headaches, dysrhythmias and psychic disorders possibly due to anaesthesia. Side effects were moderate in both groups. Recovery time was statistically significantly shorter in the propofol group and the patients in this group appeared to be much more aware after recovery than those in the thiopentone-isoflurane group.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between propofol and ketamine for anaesthesia in the elderly. Haemodynamic effects during induction and maintenance.
The haemodynamic effects of propofol and ketamine were studied in two groups of eight randomly allocated elderly patients (mean age 85.8 years) anaesthetised for hip replacement. Group 1 patients patients received propofol 1 mg/kg by intravenous bolus for induction and 0.1 mg/kg/minute by continuous infusion for maintenance. Group 2 patients received ketamine 1.5 mg/kg by intravenous bolus as induction dose and 50 micrograms/kg/minute by continuous infusion for maintenance. ⋯ Myocardial oxygen consumption showed a significant decrease of 27%. There was a significant increase in blood pressure and pulmonary capillary wedge pressure (by 97%) in group 2. Cardiac output and systemic vascular resistance remained unchanged whereas myocardial oxygen consumption showed a very significant increase of 100%.
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Randomized Controlled Trial Clinical Trial
Pain-free injection in infants. Use of a lignocaine-prilocaine cream to prevent pain at intravenous induction of general anaesthesia in 1-5-year-old children.
A randomised, placebo-controlled, double-blind study was undertaken in 111 children between the ages of 1 and 5 years to assess the efficacy of EMLA 5% cream in the alleviation of venepuncture pain at intravenous induction of general anaesthesia using 27-gauge needles. Pain assessment was made by an operating department assistant using both verbal rating scale and visual analogue scale methods. ⋯ Significantly lower pain scores were recorded in the children treated with EMLA cream (verbal rating scale: premedicated p less than 0.05, unpremedicated p less than 0.001; visual analogue scale: premedicated p less than 0.0005, unpremedicated p less than 0.0002). No variation in analgesia was found for application times between 30 and 300 minutes and there were no serious side effects.
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The effects of a bolus injection of propofol on mean intracranial pressure were studied in six adult, comatose patients who had severe head injuries. Propofol 2 mg/kg was given intravenously over 90 seconds when the mean intracranial pressure reached or exceeded 25 mmHg. Arterial blood gas values, heart rate and central venous pressure remained stable at all measurements. ⋯ The mean (SEM) intracranial pressure decreased statistically significantly (p less than 0.05) at 30 seconds and at 1 and 2 minutes, from 25 (3) to 11 (4) mmHg. The cerebral perfusion pressure decreased statistically significantly from 92 (8) mmHg at all measurements (p less than 0.05). The lowest value at 3 minutes was 50 (7) mmHg but in four patients at that time the perfusion pressure was below 50 mmHg.