Observations On Haemodynamic Effects Of Sevoflurane – Propofol Co-Induction

Background: Both Propofol and Sevoflurane have been seen to decrease the haemodynamic stress response obtained with oro-tracheal instrumentation. But they are also associated with significant depression of cardiovascular system. With the aim to gain benefit from both these agents but lessen the cardiovascular depressive manifestations, we induced the patients using both the agents in decreased dosages and observed the effects there upon on haemodynamic parameters. Methods: 30 patients were given to inhale Sevoflurane(4%) in Oxygen and were also administered intravenous Propofol (1mg/kg) for induction of general anaesthesia. Aided by IV SuccinylCholine(1mg/kg), trachea was intubated under direct laryngoscopy. Results: The Systolic , Diastolic, Mean Blood Pressure values and Pulse rates were noted before and after induction and following intubation and the observations were analysed. Conclusion: .Anaesthesia induction with Propofol and Sevoflurane combination blunts the haemodynamic stress response.

Acid-Base Imbalance and Dyselectrolytemia in Falciparum Malaria.

Malaria is re-emerging as the major infectious killer and it is the top priority tropical disease of the World Health Organization. Indian sub-continent harbours a global threat in the form of epicenter of multidrug resistant plasmodium falciparum. High prevalence of Complicated Falciparum Malaria in Costal Andhra Pradesh requiring ICU admission with high morbidity and mortality prompted this study. 60 cases of falciparum malaria in 3 sub groups, i.e, uncomplicated falciparum, severe falciparum with ARF, severe falciparum without ARF are taken. In Group-II, i.e, severe falciparum with ARF pts., mean serum potassium is 5.06 -hyperkalemia, mean PaO2 and PaCO2 are 80.33 and 32.75 respectively and mean bicarbonate value is 19.83, mean PH is 7.10, which reflects underlying metabolic acidosis and compensatory respiratory alkalosis, also mortality is 6 in Group-II out of total 9 deaths. Hence electrolytes and acid-base disturbance, especially hyperkalemia and acidosis are important cause of mortality in severe falciparum malaria. In acute renal failure setting, which is associated with both hyperkalemia and acidosis, prognosis is worsened. “Humanity has but three great enemies : fever, famine and war; of these by far the greatest, by far the most terrible, is fever(William Osler).