ABSTRACT
Information is needed as to how general practitioners (GPs) can best satisfy their patients when they are being referred to hospital. This study demonstrates the importance of involving patients in decision making and of giving them information.
Subject(s)
Patient Participation , Patient Satisfaction , Referral and Consultation , Adult , Decision Making , Female , Humans , Male , Physician-Patient Relations , Surveys and QuestionnairesABSTRACT
The effect of fentanyl, 8 micrograms/kg, used as an adjunct to thiopental for induction of anesthesia, on the circulatory response to tracheal intubation was investigated in 36 patients undergoing major vascular surgery. Patients were randomly assigned to receive either thiopental, 6 mg/kg, alone (N = 18), or thiopental, 3 mg/kg, along with fentanyl, 8 micrograms/kg (N = 18), for induction of anesthesia. The electrocardiogram, arterial pressure, pulmonary capillary wedge pressure, cardiac output, and central venous pressure were measured during induction of anesthesia, laryngoscopy, and intubation. Mean arterial blood pressure increased more following intubation in patients given thiopental than in patients given fentanyl-thiopental, reaching a peak value of 144 +/- 4 torr in patients receiving thiopental only, compared with 108 +/- 6 torr in those receiving fentanyl and thiopental (p less than 0.0001). Increases in systolic blood pressure, diastolic blood pressure, and pulmonary capillary wedge pressure with intubation were also significantly greater following administration of thiopental than following fentanyl-thiopental. Doses of fentanyl that are low enough to cause little postoperative respiratory depression significantly blunt postintubation hypertension when used as an adjunct to thiopental.
Subject(s)
Fentanyl/therapeutic use , Hypertension/prevention & control , Intubation, Intratracheal/adverse effects , Anesthesia , Fentanyl/administration & dosage , Heart Rate/drug effects , Hemodynamics/drug effects , Humans , Hypertension/etiology , Laryngoscopy/adverse effects , Random Allocation , ThiopentalABSTRACT
Of 55 abstracts presented at the 1979 annual meeting of the International Anesthesia Research Society (I.A.R.S.) 24 (43.6%) and of 62 abstracts presented at the 1980 annual meeting of the I.A.R.S. 25 (40.3%) were published by July 1, 1981. Of 324 abstracts presented at the 1978 annual meeting of the American Society of Anesthesiologists (A.S.A.) 98 papers (30.1%) were published by January 1, 1981. Eighty-two percent of the I.A.R.S. meeting papers and 66.7% of the A.S.A. papers were published in anesthesia journals, and the rest of the papers appeared in publications representing a variety of other disciplines. The average lag time between publication of the abstract and publication as an article was 8.2 months for I.A.R.S. abstracts and 12.2 months for A.S.A. abstracts. By July 1, 1981, four 1979 I.A.R.S. abstracts were filed in Science Citation Index (SCI) as cited reference and by January 1, 1981, fifty-six 1979 A.S.A. abstracts were filed.
Subject(s)
Anesthesiology , Congresses as Topic , Periodicals as Topic , Abstracting and Indexing , Societies, Medical , United StatesABSTRACT
Transient hypotension has been observed in patients after rapid intravenous administration of mannitol, 25 per cent, in clinical doses. These studies were conducted to determine the mechanism for the hypotension, to determine dose and rate of injection response curves in rabbits, and to determine which vascular beds were most reactive. Studies in six patients showed mean decreases in blood pressure of 23 +/- 6.0 per cent (+/-SE) and in total peripheral resistance of 38 +/- 7 per cent after infusion of mannitol. Studies in 18 patients during cardiopulmonary bypass with mechanically fixed cardiac output demonstrated decreases in mean blood pressure of 30 +/- 5 to 40 +/- 3 per cent, depending on dose and rate of administration of mannitol. Patients not on bypass compensated for large decreases in total peripheral resistance by increases in cardiac output (3.6 +/- .4 at baseline to 4.4 +/- .4 l/min) during mannitol-induced hypotension with no change in heart rate. Serum osmolality increased as blood pressure decreased. Significant but clinically unimportant decreases in sodium and potassium ions, hemoglobin, pH, and base excess values were observed. Studies in 18 rabbits showed that the greater the dose or rate of injection of mannitol the greater the decrease in blood pressure. Injection of radiolabeled microspheres in rabbits demonstrated a near doubling of blood flow to skeletal muscle tissue during the hypotension. This occurred with both equiosmotic hypertonic glucose (17 +/- 3 to 32 +/- 7 per cent) and mannitol (17 +/- 1 to 31 +/- 5 per cent), but not after isotonic saline solution. Changes in blood flow to other organ beds were variable and unimportant. The results suggest that hypotension following the intravenous administration of hyperosmotic solutions is due primarily to vasodilation in skeletal muscle.
Subject(s)
Blood Pressure/drug effects , Hypertonic Solutions/adverse effects , Mannitol/administration & dosage , Acid-Base Equilibrium/drug effects , Animals , Cardiac Output/drug effects , Cardiopulmonary Bypass , Dose-Response Relationship, Drug , Hemoglobins/analysis , Humans , Hydrogen-Ion Concentration , Hypertonic Solutions/administration & dosage , Male , Mannitol/adverse effects , Muscles/blood supply , Osmolar Concentration , Potassium/blood , Rabbits , Sodium/blood , Vascular Resistance/drug effects , Vasodilation/drug effectsABSTRACT
The median as well as the ulnar nerve may be used effectively in the evaluation of neuromuscular blockade with the peripheral nerve stimulator. Both ulnar and median nerve stimulation produce flexion of the fingers. For maximum neural stimulation either during the routine use of the peripheral nerve stimulator or when it is used as an aid to peripheral nerve block, the negative pole should be attached to the exploring needle or over the nerve to be stimulated.
