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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 51 (1996), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Prolongation of the QT interval may cause potentially hazardous arrhythmias. The effects on the QT interval (QTc, corrected for heart rate) of isoflurane and halothane followed by vecuronium have been investigated during induction of anaesthesia in 51 patients. All patients were ASA 1 or 2, without cardiovascular problems or electrolyte abnormalities and were not receiving medication. Midazolam 0.08mg.kg-1 was administered intramuscularly for premedication. Anaesthesia was induced with either isoflurane (n = 26) or halothane (n = 25), and the inspired concentration increased to reach an end-tidal concentration of 2.5% to 3%. Recordings of ECG, heart rate, systolic and diastolic arterial pressure were obtained at the following times: prior to induction of anaesthesia; 1 min and 3 min after a stable end-tidal concentration had been reached; 1 min and 3 min following vecuronium administration, at the time of tracheal intubation and 1 min and 3 min later. Halothane significantly shortened QTc (p 〈 0.05 to p 〈 0.001), in contrast to isoflurane which prolonged it (p 〈 0.01). The heart rate decreased (p 〈 0.01 to p〈 0.001) after induction of anaesthesia with halothane and returned to pre-induction values after tracheal intubation. In contrast, heart rate increased after induction with isoflurane and increased further after laryngoscopy and tracheal intubation (p 〈 0.001). In the isoflurane group, ST depression was noticed in seven patients and nodal rhythm in two, while in the halothane group seven patients developed nodal rhythm and, in two patients, ventricular ectopics were recorded. There were no sequelae. In both groups, systolic and diastolic arterial pressure decreased after induction of anaesthesia (p 〈 0.01 to p 〈 0.001), increasing again after intubation.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Nasopharyngeal pressures were compared in eight subjects breathing through either a nasal CPAP system or facemask CPAP system at afresh gas flow of 50, 75 and 100 l.min−1. During nose breathing there was no significant difference in nasopharyngeal pressure between the two systems. During mouth breathing pressures were significantly lower with nasal CPAP. During nose breathing at 75 l.min−1 the mean inspiratory and expiratory pressures in cmH2O (SD) were 3.4 (0.68) and 5.9 (0.55) for nasal CPAP and 3.3 (0.71) and 6.3 (0.73) for facemask CPAP. The respective pressures during mouth breathing were 0.3 (0.73) and 2.9 (1.74) for nasal CPAP and 3.9 (0.73) and 5.8 (0.82) for facemask CPAP.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary We compared the cost-effectiveness of general anaesthetic agents in adult and paediatric day surgery populations. We randomly assigned 1063 adult and 322 paediatric elective patients to one of four (adult) or two (paediatric) anaesthesia groups. Total costs were calculated from individual patient resource use to 7 days post discharge. Incremental cost-effectiveness ratios were expressed as cost per episode of postoperative nausea and vomiting (PONV) avoided. In adults, variable secondary care costs were higher for propofol induction and propofol maintenance (propofol/propofol; p 〈 0.01) than other groups and lower in propofol induction and isoflurane maintenance (propofol/isoflurane; p 〈 0.01). In both studies, predischarge PONV was higher if sevoflurane/sevoflurane (p 〈 0.01) was used compared with use of propofol for induction. In both studies, there was no difference in postdischarge outcomes at Day 7. Sevoflurane/sevoflurane was more costly with higher PONV rates in both studies. In adults, the cost per extra episode of PONV avoided was £296 (propofol/propofol vs. propofol/ sevoflurane) and £333 (propofol/sevoflurane vs. propofol/isoflurane).
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Two groups of 14 patients were compared after coronary artery bypass surgery where the left internal mammary artery had been used as a conduit. One group received nasal continuous positive airway pressure for 1 h, the other group acted as a control. Mean pulmonary shunt fraction was 16.3% before, 12.6% during and 15.7% after continuous positive airways pressure. In the control group the shunt fraction fell from 17.3% to 16.8%. The reduction in shunt fraction was significantly greater with nasal continuous positive airways pressure than in the control group (p = 0.016). There was a significant reduction (p = 0.025) in respiratory rate from 18.3 to 16.7 breath.min–1 during continuous positive airway pressure. Other measured cardiorespiratory variables did not differ significantly between the groups. Visual analogue scores showed no significant difference in chest pain or mask comfort between the groups. The ease of breathing score was, however, significantly better in the continuous positive airways pressure group, 7.5 (SD 1.8) cm and control 5.6 (SD 2.6) cm.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This is a report of a large selfadministered overdose of temazepam and meprobamate. The administration of Jumazenil (Ro 15-1788) led to the partial antagonism of the depressant action of the drugs which was sufficient to avoid the need for invasive respiratory and cardiovascular support.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Analysis of heart rate variability has been used to study the effects of midazolam, morphine and clonidine on the autonomic nervous system, when administered to patients for premedication. Ninety-five patients were studied 60 min before and 60 min after premedication. Normal saline (n = 25), midazolam 0.08 mgkg−1 (n = 24), morphine 0.15 mgkg−1 (n = 23), or clonidine 2 μgkg−1 (n = 23) were administered intramuscularly by random allocation. A Holter device was connected to the patient during the study period. Using power spectral analysis the low-frequency and high-frequency components were calculated from the Holter recordings. These are markers for sympathetic and parasympathetic activity respectively; the low- to high-frequency ratio was also calculated, a ratio of 〉1 signifying sympathetic dominance. A significant reduction was noticed in both low-frequency and high-frequency power in the three premedicated groups, whereas no changes were observed in the normal saline group. In the case of midazolam, both the low and high frequencies were decreased but the low- to high-frequency ratio did not change significantly. Morphine and clonidine depressed the low-frequency component more than the high-frequency component and the low- to high-frequency ratio was decreased, suggesting parasympathetic dominance. We conclude that heart rate variability may be a useful tool for investigating the effect of drugs on the autonomic nervous system.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 37 (1982), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A case is described of a baby born with a combination of a paralysed hemidiaphragm and congenital hypothyroidism which led to the need for artificial ventilation. Difficulties were encountered in discontinuing the ventilatory support. The problems involved in timing extubation of infants are discussed together with consideration of the diagnosis and treatment of neonatal hypothyroidism.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Oxford : Blackwell Science Ltd
    Anaesthesia 54 (1999), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A postal survey of all 269 acute hospital trusts identified in the United Kingdom was carried out to study the work of Clinical Directors of anaesthesia. Initial responses from 163 Clinical Directors and 129 completed questionnaires were analysed. Four main areas of concern revealed by the survey were contracts and objectives, funding of managerial sessions, access to information and perceived need for support. Most Clinical Directors had no job description and most had no formal written objectives, despite a substantial body of advice that these should be provided. There was generally substantial underfunding of managerial hours compared with those actually worked and approximately 20% of Clinical Directors surveyed had no funding for managerial duties. Clinical Directors' ratings of the information available to assist their decision making were also a cause of concern. Clinical Directors perceived that they need better networking, more training particularly on human resource management and improved management information.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1238
    Keywords: Neuromuscular blocking agents ; Atracurium ; Cisatracurium ; Recovery ; Neuromuscular blockade ; Intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To investigate the infusion requirements and recovery characteristics of cisatracurium compared with atracurium when both are administered by prolonged continuous infusion. Design A prospective, randomised, single-blind study. Settings The Intensive Care Unit of the Manchester Royal Infirmary. Patients 20 patients requiring a continuous infusion of a neuromuscular blocking agent to facilitate mechanical ventilation. 12 patients received cisatracurium and 8 received atracurium. Interventions Cisatracurium or atracurium was administered by continuous infusion for a minimum of 24h. The level of neuromuscular blockade was measured by recording the train-of-four responses using acceleromyography, the aim being to maintain 1–2 twitch responses of the adductor pollicis. At the end of the infusion period, the train-of-four was recorded until the ratio was greater than 0.7. Measurements and results The mean infusion rate of cisatracurium was 0.23 mgkg−1 h−1, compared to 0.62 mgkg−1 h−1. No time-related increase in infusion requirements was seen for either drug. The mean recovery time to a train-of-four ratio greater than 0.7 was the same (46 min). There was no correlation between recovery time and age, duration of infusion or mean infusion rate. Conclusions Cisatracurium provides a satisfactory level of neuromuscular blockade in adult ICU patients at approximately one-third the infusion rate of atracurium and with a similar recovery time.
    Type of Medium: Electronic Resource
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