[Intra-atrial ECG via a central venous catheter]. / Intra-atrialt ekg via centralt venekateter.

The authors registered measurements of ECG via the saline column in a central venous catheter in a prospective investigation. The P-waves in the atrial ECG from various heights in the atrium and low down in the superior vena cava were compared with lead II in surface ECG and this revealed significantly larger P-waves in the invasive ECG. In patients with tachyarrhythmia, who have or require a central venous catheter, the atrial ECG will thus present an alternative to the oesophageal ECG in the diagnostic elucidation. The method is found to be easy to carry out and it is without risks or discomfort for the patient and it provides good information about atrial activity.

Flumazenil in total intravenous anaesthesia using midazolam and fentanyl.

Forty patients, scheduled for elective surgery in a thoracic and vascular surgical unit, were anaesthetized by a total intravenous anaesthesia technique using midazolam and fentanyl. Subsequent reversal of anaesthesia by the specific benzodiazepine antagonist flumazenil was evaluated in a double-blind trial. The patients were observed in the recovery room postoperatively until the next morning, and their recovery was repeatedly evaluated during the first 240 min after anaesthesia. Six patients in the placebo group required an oral airway or an endotracheal tube during the first hours of recovery, whereas none who received flumazenil did. The respiratory rate was significantly higher after flumazenil than placebo during the first 4 h postoperatively (Anova, P less than 0.01). Blood pressure and heart rate were not different between the two groups. The degree of sedation, orientation in time and space and the ability to cooperate were significantly superior after flumazenil than placebo (Anova, P less than 0.01). Some degree of resedation was observed in both groups, affecting 95% of the patients who received flumazenil against 30% after placebo (Mann-Whitney, P less than 0.05). No adverse reactions attributable to the use of flumazenil were encountered.

In vitro effect of etomidate and thiopental on granulocyte migration.

An increased mortality has been reported during long-term etomidate infusion. Inhibition of adrenal corticosteroid synthesis has been incriminated - but other factors related to host defence cannot be excluded. Using an under-agarose assay, we investigated the effect of etomidate on in vitro granulocyte migration. Unlike thiopental (50 micrograms/ml), etomidate (4-32 micrograms/ml) did not affect either spontaneous or directed migration. Impaired granulocyte migration is an unlikely cause of morbidity during long-term etomidate infusion.