Summary Tlic licie~r~iod~~riatriic response to traclieal intubation wus compared inThe haemodynamic consequcnces of laryngoscopy and tracheal intubation have been reported for many years'-4 and may be sevcre enough to have scrious myocardial 5 -8 and cerebral efPect~.~ ' ) Scvcral methods have been described to protcct against this r c s p o n~c . '~-'~ It was noted recently that these changes arc attenuated, although not abolished after induction of anaesthesia with propofol.20-23The present study investigated the effects of three induction agcnts. thiopentone, etomidate and propofol, with and without fentanyl. on the haemodynamic response to tracheal intubation. MethodsStudies were carried o u t on 303 patients between 16 and 60 years of age, ASA gradc 1 or 2, who were to undergo surgery that required trachcal intubation. Hypertensive patients or those with knohn allergy to any of thc drugs used were not studied. The protocol also allowed exclusion of the results of any patient who proved difficult to intubate or who coughed during trachcal intubation: there were 12 such patients in the study.The patients were randomly allocated into six groups to receive the following induction agents: thiopentone 4 rng/kg with and without fentanyl 2 pgikg; etomidate 0.3 mg/kg with and without fentanyl 2 pg/kg: and propofol 2.5 mg/kg with and without fentanyl 2 pgikg. All patients received intramuscular premedication with atropine 0.6 mg and papaverctum ]--I .S hours bcforc opcration. The dose of papaveretum varied according to the patients' weight: 7 0 kg, 20 mg. Procl~dureA conventional four-lead ECG was attachcd on arrival in the anaesthetic room and lead 2 displayed continuously. A strip recorder was used to identify any dysrhythmias. An automatic blood pressure cuff (Dinamap) was attached to one arm and an indwelling cannula inserted into a vein in the other arm for drug administration. Measurements of arterial blood pressure were made 10 minutes. 5 minutes and immediately prior to induction.Fentanyl 2 /@kg (or an appropriate volume of saline) was then injcctcd over 30 seconds. The induction agent was also injcctcd over 30 seconds. one minute after the start of thc fcntanyl injection and immediately after tneasurements had been made. The patient then breathed 70°h nitrous oxidc in oxygen via a Magill system; ventilation was assisted gently if necessary. Suxamethonium 1.5 mgikg was injected during IS seconds immediately after the next nieasurements. one minute after the start of induction, and vcntilation controlled. The trachca was intubated with a cuffcd tube 2 minutes after the start of the suxamcthonium injection and the lungs ventilated with thc same mixture. Measurerncnts were taken immediately prior to laryngo-C.E. Harris, FFARCS.

The concomitant use of dexmedetomidine in patients undergoing spinal fusion reduces propofol infusion requirements when compared with those patients receiving only propofol and remifentanil.

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An evaluation of a newly CE approved bedside monitoring device used in a general hospital ward is presented. This evaluation has shown that it is feasible to use the system within this environment to provide medical staff with supplementary information on patient health, at more frequent intervals than traditional monitoring methods. The physiological data recorded by the body worn device is wirelessly transmitted to a patient management system for storage and display. Good correlation between heart rate values recorded by hospital staff and those recorded by the automated Vitalsens VS100 system was observed. The system has highlighted clinical information that routine observations alone did not readily identify. This can provide clinicians with a better view of the overall health status of the patient. Such medical issues include those witnessed in this study, namely paroxysmal AF, ectopic beats, increasing heart rates recorded prior to a hypoglycaemic event, general high and low heart rate trends and various instances where clinically relevant ECG data has been captured.