Biomedical subjects
Publications and source records attributed to B M Braude.
The successful administration of an etomidate infusion as a supplement to droperidol, fentanyl, muscle relaxant, air and oxygen anaesthesia in an 8-hour neurosurgical procedure is described. The merits of this technique are discussed, with particular emphasis on the conduct of anaesthesia in a patient with raised intracranial pressure.
A 24-year-old woman underwent resection of a phaeochromocytoma. Invasive haemodynamic monitoring was undertaken. Pre-operative alpha-blockade was not instituted and the blood pressure fluctuated widely. The pulmonary capillary wedge pressure and central venous pressure measurements did not correlate well in this patient. Possible reasons for this discrepancy, the value of the pulmonary artery catheter and the advisability of pre-operative alpha-blockade are discussed.
Total anaesthesia using a combination of droperidol and fentanyl and an etomidate infusion was induced and maintained intravenously in a 29-year-old patient undergoing laparotomy for a colonic resection. Post-operatively the patient complained of awareness. Possible explanations for this are discussed.
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Nitrous oxide concentrations (V/V) at the delivery Rotameters block, nasal mask, pharynx and venous blood, were compared. There was a dilution of approximately 50% of the delivered nitrous oxide at the nasal mask which was further reduced in the pharynx. Venous blood concentrations 10 minutes after inhalation of nitrous oxide were low but as would be calculated from pharyngeal concentrations. After 5 minutes of oxygenation venous blood nitrous oxide concentrations were still relatively high. A total of 92% of subjects experienced a satisfactory effect with 30% nitrous oxide or less in the pharynx.
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A patient developed fever and acute hepatitis shortly after enflurane anaesthesia. Other causes of postoperative hepatitis were excluded. Cross-sensitization with halothane may have occurred, and the enflurane hepatitis may have been aggravated by halothane hepatitis.