The cardiovascular and myocardial effects of propofol and etomidate were studied in 20 geriatric patients (age 65-84 years) who underwent major upper abdominal surgery. Ten patients received propofol 1.5 mg/kg for induction of anaesthesia followed by a continuous infusion of 0.1 mg/kg/minute for maintenance; 10 patients received etomidate 18 mg for induction followed by 2.4 mg/minute for maintenance. Vecuronium was used for neuromuscular blockade. Cardiovascular dynamics were recorded in the awake state one minute after induction and 1, 5 and 30 minutes after tracheal intubation; coronary blood flow (argon wash-in) and myocardial oxygen consumption were determined in the awake state and 5 and 30 minutes after intubation. Both anaesthetics decreased systolic, diastolic and mean arterial pressures, heart rate and cardiac index to the same extent. Myocardial blood flow and oxygen consumption were also reduced in both groups due to a reduction in cardiac work. Tracheal intubation produced a marked increase in arterial pressure in the etomidate group, while haemodynamic changes were absent in the propofol group, Myocardial lactate production was not observed in either group 5 or 30 minutes after tracheal intubation.

The aim of the study was the determination of the influence of ventilation modes on the consumption of analgesics and sedatives, duration of intubation and pulmonary gas exchange. Assist/controlled mandatory ventilation (S-CMV, 123 patients), synchronized intermittent mandatory ventilation (S-IMV, 431 patients) and biphasic positive airway pressure ventilation (BIPAP, 42 patients) were compared in a prospective, controlled, open clinical trial over an 18-month period. Five hundred and ninety-six adult patients with normal pulmonary function before surgery and uneventful course following coronary artery bypass graft surgery were studied. Patients ventilated with BIPAP had a significantly shorter mean duration of intubation (10.1 h, P < 0.05) than patients treated with S-IMV (14.7 h) and S-CMV (13.2 h). In the S-CMV group, 39.9% of the patients required single or multiple doses of midazolam, but only 13.5% in the S-IMV group and 9.5% in the BIPAP group. The mean total amount of midazolam administered to these patients was significantly higher in the S-CMV group (8.8 mg) than in the S-IMV group (6.6 mg, P < 0.05) and in the BIPAP group (4.3 mg, P < 0.05). The consumption of pethidine and piritramide did not differ between S-CMV and S-IMV, but was significantly lower during BIPAP (P < 0.05). After extubation the patients' PaCO2 was highest in the S-CMV group. We conclude that ventilatory support with BIPAP reduces the consumption of analgesics and sedatives, and the duration of intubation. The possibility of unrestricted spontaneous breathing in all phases of the respiratory cycle is considered to be the reason. BIPAP seems to be an alternative to S-CMV and S-IMV in short-term ventilated patient.

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This rewarming technique seems safe and effective and allowed the controlled rewarming of our patients who suffered from severe accidental hypothermia

Efficiency data that allow a direct comparison with heat and moisture exchangers data according to ISO/EN-9360:2000 can also be determined for HH. HH do not prevent pulmonary water losses in intubated patients. These losses can exceed the physiological range. The airway resistance of the Cascade II prohibits its use in spontaneously breathing patients. The warning and shut-off features of HH are unacceptable and hazardous.