No abstract
Effects of alfentanil, preceded by lorazepam, on suppression of haemodynamic and somatic responses to noxious stimuli was studied in patients undergoing CABG. Plasma concentration of alfentanil, somatic and haemodynamic responses were measured at loss of consciousness, tracheal intubation, sternotomy and during multiple application of electrocoagulation. Additional alfentanil was administered i.v. to control unwanted responses. Study 1 (six patients): lorazepam 0.08 mg kg-1 by mouth 1-2 h before operation, alfentanil priming infusion (60 micrograms kg-1 min-1 for 10 min) followed by maintenance infusion (4.5 micrograms kg-1 min-1). With mean plasma alfentanil 1178 (SEM 54) ng ml-1, two patients required supplementary alfentanil to suppress somatic motor responses; one patients required nitroglycerin to control an increase in arterial pressure which was unresponsive to additional alfentanil following sternotomy. Study 2 (13 patients): lorazepam 0.04 mg kg-1 by mouth as premedication; one of three maintenance infusion rates of alfentanil: 5.4 (n = 4), 6.6 (n = 5), or 7.8 (n = 4) micrograms kg-1 min-1, each preceded by a proportional priming infusion. With plasma alfentanil 2181 (62) ng ml-1, somatic motor responses requiring additional alfentanil occurred in nine patients; haemodynamic responses in four of seven patients tested could not be controlled by alfentanil. The highest plasma concentration of alfentanil to prevent response to a stimulus other than tracheal intubation was different between the two studies (P less than 0.05). We conclude that alfentanil alone is insufficient to suppress haemodynamic and somatic motor responses to noxious stimulation during CABG and that the role of premedication is significant.
The prestige of the landlord class, which had stood so high in the long period of prosperity of the mid-Victorian years, fell to its lowest point in the last quarter of the nineteenth century. From the early 1880's landowners were attacked by politicians and land reformers in Parliament, in the Press and in a welter of literature on various aspects of the land question. At the same time there was a revival in the membership and activities of land organisations many of which had been started in the land agitation of the early 1870's only to go down before the onset of the Great Depression. The main cause of the widespread feelings of hostility towards landowners was economic: the instability of trade and employment and the effects of falling profit margins on the outlook and standards of expenditure of businessmen. The conflict of economic interests between landlords, businessmen and workers was expressed in the language of class war. Radicals of the Liberal Party took advantage of the increased support given to them by the business and professional classes to renew their campaign against the landowning aristocracy. They carped at the wealth of landowners and pointed to the burden of rents and royalties which lay on the enterprise of farmers and mineowners. They contrasted the relatively fixed incomes of landowners with the falling rate of return on industrial investments. Turning away from moderate reforms designed to improve the transfer and development of estates, they pronounced that the chief burden on the land was not the law but the landlord himself.
No abstract
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