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  • 1
    ISSN: 1432-1041
    Keywords: ketorolac ; morphine ; ventilation ; CO2 response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary We have compared the effect on ventilation of ketorolac, an injectable non-steroidal analgesic, with that of morphine in a randomized, double-blind, cross-over study, using two doses of ketorolac (10 and 90 mg i.m.) and one of morphine (10 mg i.m.). The effect on ventilation was measured with a CO2 rebreathing technique. As a measure of the effect we studied the increase in PETCO2 (CO2 shift) that caused a respiratory minute volume (RMV) equal to the RMV in the control period at 8 kPa PETCO2. Ketorolac caused insignificant CO2 shifts of about 0.10 kPa, while morphine caused a significant CO2 shift of 0.86 kPa. We conclude that ketorolac in analgesic and supra-analgesic doses has no effect on the ventilatory response to CO2 under circumstances in which significant effects are seen with morphine.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Duplex sonography was used to determine the changes in mesenteric arterial blood flow occurring in patients undergoing aortic surgery, anaesthetised either by total intravenous anaesthesia with propofol and sufentanil (group A) or inhalational anaesthesia with isoflurane and nitrous oxide (group B). Sixteen patients were studied. Measurements were performed immediately before and 15 min after induction of anaesthesia, before surgery. There was a 38% decrease (p = 0.015) in the superior mesenteric artery end diastolic velocity in group A and a 23% decrease (p = 0.033) in the superior mesenteric artery peak systolic velocity in group B. There were no changes in any of the other sonography parameters in either group. We conclude that neither total intravenous anaesthesia with propofol and sufentanil nor inhalational anaesthesia with isoflurane and nitrous oxide have any clinically significant influence on mesenteric blood flow in the absence of surgical stimulation.
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  • 3
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The efficacy of thoracic epidural sufentanil 50 μg was compared with lumbar epidural sufentanil 50 μg in 30 patients (n = 15 in each group) undergoing lateral thoracotomy. Sufentanil was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg-1 and thiopentone 2–5 mg.kg-1 intravenously. Anaesthesia, nitrous oxide 66%, halothane 0.3% and sufentanil 25 μg intravenously were given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre-operative value and heart rate exceeded 90 beat.min-1 in the absence of hypovolaemia, or when other autonomic or somatic signs were seen. Four patients in the thoracic epidural group and five in the lumbar epidural group needed supplementary sufentanil. Six patients in the thoracic epidural group and three in the lumbar epidural group each had a single hypotensive episode. Lumbar and thoracic epidural sufentanil are equally effective in contributing to intra-operative analgesia for lateral thoracotomy.
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  • 4
    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: Forty-three surgical patients were, during general anaesthesia, presented (via headphones) with either statements about common facts of some years ago (group A), or new verbal associations, i.e. the names of fictitious, nonfamous people (group B). None had any recall of intra-operative events. In a postoperative test of indirect memory, patients in group A answered more questions about the ‘common facts’ correctly than those in group B (p 〈 0.005), which reflects the activation of pre-existing knowledge. Furthermore, patients in group B designated more ‘nonfamous names’ as famous (thus falsely attributing fame) than patients in group A (p 〈 0.001), which demonstrates that information-processing during anaesthesia can also take place as unconscious learning.
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  • 5
    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: The dose requirement of alfentanil as a supplement to nitrous oxide anaesthesia was studied in 13 patients with Crohn's disease and seven control patients all of whom underwent laparotomy. Alfentanil was administered as a variable rate infusion with supplemental bolus injections titrated to the patient's needs. The alfentanil requirement was independent of the duration of surgery and was significantly higher in patients with Crohn's disease than in control patients. The results indicate that Crohn's disease alters the dose requirement of alfentanil.
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  • 6
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Eighty-three patients were given midazolam 0.1 mg.kg-1 by intramuscular injection as premedication before general anaesthesia with alfentanil-nitrous oxide. During anaesthesia patients were presented (through headphones) with either statements about common facts of some years ago (group A) (n = 43) or new verbal associations, e.g. names of fictitious, nonfamous people (group B) (n = 40). In a previous study with the same anaesthetic technique, but without premedication there was significant activation of implicit memory (p 〈 0.001). In this study we found no explicit or implicit memory for the auditory information presented during anaesthesia. Midazolam premedication can prevent implicit memory activation during alfentanil-nitrous oxide anaesthesia.
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  • 7
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The effects of epidural administration of alfentanil on the intravenous alfentanil dose requirements and the plasma concentrations required to suppress responses to surgical stimulation during nitrous oxide-oxygen-alfentanil anaesthesia in 20 patients undergoing lower abdominal surgery were studied. Before induction of anaesthesia, patients in one group (E) received an epidural injection of 1mg alfentanil, followed by an epidural infusion of alfentanil 0.2mg.h-1 until skin closure, whilst patients in the other group (C, control) received a continuous infusion of sodium chloride via a sham catheter in order to blind the main investigator to the treatment. Anaesthesia was induced and maintained with nitrous oxide (66%) in oxygen and a‘target’-controlled intravenous infusion of alfentanil. During surgery, the‘target’alfentanil concentration was increased or decreased according to patients’responses. The number of responses to surgical stimulation was smaller in patients from group E (median 1, range 0-3) than in patients from group C (median 4, range 1–15; p 〈 0.005), even though the alfentanil intravenous infusion rates were smaller in group E [mean (SD): 1.6(0.5)μg.kg-1min-1] than in group C [2.9(1.2)μg.kg-1min-1, p 〈 0.02]. Both the lowest concentrations associated with no response [133(40)ng.ml-1]and the highest concentrations associated with a response [155(65)ng.ml-1] in group E were lower than those in group C [238(100) ng.ml-1, p 〈 0.01 and 334(163) ng.ml-1, p 〈 0.05, respectively]. We concluded that epidural administration of alfentanil reduces intravenous alfentanil requirements during nitrous oxide-oxygen-alfentanil anaesthesia for lower abdominal surgery. The results indicate a spinal mechanism of action of epidural alfentanil.
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  • 8
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A retrospective analysis is presented of all reports of faults, accidents, near accidents and complications associated with anaesthesia in one hospital from 1978 to 1987. 113074 anaesthetics were administered in that period, of which 97496 were for noncardiac procedures. There were 148 reports; 39 were of dental damage. Peri-operative cardiac arrests during noncardiac surgery were reported 29 times. Sixteen of these were fatal. Anaesthesia was thought to have played an important role in 13 cardiac arrests (1 per 7500 anaesthetics) and six were not successfully resuscitated (1 per 16 250 anaesthetics). There were 12 reports of postoperative peripheral neuropathies (1 per 9422 anaesthetics). Failure to check, lack of vigilance and inattention or carelessness were the most frequently associated factors with the rest of the reports.
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  • 9
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The plasma concentration-time profile of alfentanil following epidural administration was determined in eight patients undergoing lower abdominal surgery under nitrous oxide (66%)-oxygen (33%)-halothane (0.3%) anaesthesia, supplemented with intravenous sufentanil. Alfentanil (1 mg) was administered epidurally before induction of general anaesthesia. Blood samples for the determination of plasma alfentanil concentrations by capillary gas chromatography were collected at intervals until 12h after the epidural injection. Peak plasma concentrations [mean (SD)] were 9.7 (2.3)ng.ml-1, and were attained in a median (range) time of 90 (30-120) min. The results suggest that alfentanil is slowly absorbed from the epidural space into the general circulation.
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  • 10
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 26 (1971), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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