Although the in-hospital mortality rate was similar to previously published figures, the rate increased considerably when commonly encountered risk factors were present.
Department of Anesthesiology, Hospital of the University of PennsylvaniaIt is commonly believed that the anesthetic actions of thiopental are terminated, not by metabolism of the drug, but by its concentration in body fat.2 Thiopental t is highly fat soluble, 3 but it has not been shown that its uptake by adipose tissue occurs rapidly enough to account for the speed with which consciousness is regained after intravenous injection of the drug. We have attempted to study this point. 9 Our conclusion is that fat does not play the role which has been ascribed to it. Fat concentrates thiopental so slowly that the rate of recovery from anesthesia ordinarily depends to a far greater extent upon the mass of the body than upon its fat content. Reasons for these statements, together with a quantita-
Changes in cardiac index (CI) and estimated systemic vascular resistance (ESVR) were assessed non-invasively using pulsed Doppler ultrasound during induction of anaesthesia. Ninety-six ASA I patients were allocated randomly to one of four groups to receive alfentanil 8 micrograms kg-1 followed by a dose of thiopentone, methohexitone, propofol or etomidate sufficient to obtund the eyelash reflex. CI increased significantly by 8% 1 min after administration of both methohexitone (P < 0.05) and propofol (P < 0.05), returning to pre-induction values thereafter. CI increased after thiopentone but the increase was not statistically significant. There was a significant decrease in CI of 16% after induction with etomidate (P < 0.001). ESVR decreased significantly from pre-induction values by 18% after methohexitone (P < 0.001) and 23% after propofol (P < 0.001). ESVR in the thiopentone group decreased, but this was not statistically significant. ESVR increased significantly by 12% 1 min after induction of anaesthesia with etomidate (P < 0.05) and then decreased towards pre-induction values. The results suggest that the cardiostability of etomidate may not be as complete in all groups of patients as previous studies have suggested.
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