Research Articles (Anaesthesiology and Critical Care)

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Browsing Research Articles (Anaesthesiology and Critical Care) by Subject "Anesthetics"

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    Induction of anaesthesia with propofol according to the adjusted ideal body mass in obese and nonobese patients : an observational study
    (Taylor & Francis Group, 2019) Smith, F. J.; Jurgens, F. X.; Coetzee, J. F.; Becker, P. J.
    ENGLISH ABSTRACT: Obesity changes body composition including fat free mass (FFM), regarded as the “pharmacologically active mass”. Scaling drug doses to obese patients by total body mass (TBM) results in overdose. We aimed to determine the success rate of inducing anaesthesia in normal, overweight and obese patients with propofol, using an adjusted body mass scalar (ABM), which embodies the increased FFM of obese patients. Methods: Ninety-six patients were divided into three groups according to body mass index (BMI): normal, overweight and obese. Propofol 2 mg/kg ABM was administered according to the equation: ABM = IBM + 0.4(TBM – IBM), where IBM = ideal body mass. Induction success was assessed clinically and by electroencephalographic spectral entropy. Results: The groups were similar regarding gender, age, height and IBM. One patient was morbidly obese (BMI = 44). State entropy (SE) decreased to < 60 in 33/33, 28/29 and 33/34 patients in the normal-weight, overweight and obese groups respectively, an overall success rate of 97.5% (95% confidence interval 92.7% to 99.4%). Median lowest achieved SE values and median times that SE remained < 60 did not differ between groups, however the individual values ranged widely in all three groups. Induction failed in the two patients whose SE did not decrease to < 60 (one overweight and one obese). Conclusions: The ABM-based propofol induction dose has a high success rate in normal, overweight and obese patients. Further studies are required to determine the feasibility among morbidly obese patients.
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    Oral midazolam in paediatric premedication
    (Health & Medical Publishing Group, 1991) Payne, K. A.; Coetzee, A. R.; Mattheyse, F. J.; Dawes, T.
    In a premedication study involving 135 children, aged 1-10 years, four regimens were investigated: (i) no premedication; (ii) oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg, droperidol 0.15 mg/kg (TMD); (iii) intramuscular midazolam (Dormicum; Roche) 0.15 mg/kg; and (iv) oral midazolam 0.45 mg/kg. All premedications were given 60 minutes before a standard halothane anaesthetic. No impairment of cardiovascular stability occurred but after premedication the mean oxygen saturation decreased by 1.6% and 1.1%, respectively, in the intramuscular midazolam and TMD groups. Overall, children under 5 years of age behaved less satisfactorily in the holding room and at induction, than those over 5 years (P<0.01). Midazolam, intramuscularly and orally, produced more satisfactory behaviour than the other two regimens (P<0.05) and, combined with a 70% more rapid recovery than the TMD regimen (P<0.05), suggests that oral midazolam is a more effective paediatric premedication agent than placebo or TMD.
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    The use of propofol in a group of older patients undergoing oesophagoscopy
    (Health & Medical Publishing Group, 1988) Steegers, P. A.; Foster, P. A.
    Propofol (Diprivan; Stuart) a new, very short-acting intravenous anaesthetic agent, was tested in its aqueous emulsion formulation. Used as an induction and maintenance agent, its anaesthetic properties, dosage requirements and side-effects were compared with those of thiopentone in 40 American Society of Anesthesiologists class I and II patients scheduled for routine oesophagoscopy. Both heart rate and diastolic blood pressure were more stable in the propofol group, and recovery times were significantly shorter. Patients were remarkably clear-headed after propofol. When the quality of anaesthesia was independently assessed by an anaesthesist and a surgeon, propofol was rated good or satisfactory in all subjects, and thiopentone in 80%. Anaphylactoid reactions associated with the previous Cremophor EL formulation were not encountered, and pain on injection was experienced in 10% of propofol subjects as against 5% who received thiopentone. This new intravenous agent produces safe and predictable anaesthesia followed by rapid recovery, making it especially suitable for outpatient anaesthesia.