SummaryForty ASA 1 patients presenting for minor gynaecological surgery were randomly allocated into four study groups to compare the haemodynamic effects of adding diyerent doses of ephedrine to an induction dose of propofol. Heart rate, oxygen saturation and non-invasive arterial blood pressure were monitored before and for Smin after induction. In those patients who received propofol alone, there was a significant decrease in both systolic (p < 0.001) and diastolic (p = 0.003) blood pressure. The addition of ephedrine 15 mg or 20 mg to 1 % propofol20 ml was very effective in maintaining blood pressure at pre-induction values. There was a statistically significant increase from baseline in systolic @ = 0.004) and diastolic (j = 0.031) pressures, but this only occurred at 1 min postinduction. The addition of ephedrine 10 mg was insuficient to prevent hypotension. There was no signijcant effect on either heart rate or oxygen saturation in any group. We conclude that ephedrine may be safely employed to reduce the degree of hypotension during induction with propofol in this patient group. Key wordsAnaesthetics, intraveneous; propofol. Sympathetic nervous systems; pharmacology, ephedrine.Propofol has gained widespread popularity as an induction agent because of the ease and reliability of its use together with its short duration of action and minimal hangover effect. It can, however, cause hypotension and bradycardia [I, Ephedrine has been used for many years to counteract similar problems in spinal and epidural anaesthesia [lo]. In addition to its a vasoconstrictor and fl cardiac stimulant effects, ephedrine also has the advantage of being shortlived, so giving it a similar action profile to propofol. We assessed the haemodynamic effects of adding various doses of ephedrine to propofol to obtund this response and to determine the optimal dose. As propofol is known to have a hypotensive action even in young, fit individuals, we decided to assess the safety and efficacy of this combination in ASAl patients. MethodsAfter obtaining approval from the local ethics committee, and with informed consent, we studied 40 unpremedicated ASAl patients presenting for minor gynaecological surgery. Following insertion of an intravenous cannula, monitoring of arterial blood pressure (non-invasive), electrocardiograph (ECG), and peripheral oxygen saturation (Spo?) was instituted for up to 5 rnin before induction, or until the measured parameters were stable. Anaesthesia was induced with one of the study treatments shown in Table 1, allocated in random order. A dose sufficient to obtund the eyelash reflex was given over 40s and the amount recorded. Patients then breathed a mixture of 60% nitrous oxide in oxygen during the study period and before the start of surgery. The ECG and Spa? were monitored continuously and arterial blood pressures recorded at 1 min intervals for up to 5 min after injection of the induction agent. Two anaesthetists were present during the whole of the study period, and the administering anaesthetist was una...

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

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The marked vasodilator and negative inotropic effects of propofol are disadvantages in frail elderly patients. We investigated the safety and efficacy of adding different doses of ephedrine to propofol in order to obtund the hypotensive response. The haemodynamic effects of adding 15, 20 or 25 mg of ephedrine to 200 mg of propofol were compared to control in 40 ASA 3/4 patients over 60 years presenting for genito-urinary surgery. The addition of ephedrine to propofol appears to be an effective method of obtunding the hypotensive response to propofol at all doses used in this study. However, marked tachycardia associated with the use of ephedrine in combination with propofol occurred in the majority of patients, occasionally reaching high levels in individual patients. Due to the risk of this tachycardia inducing myocardial ischemia, we would not recommend the use in elderly patients of any of the ephedrine/propofol mixtures studied.

American Indian patients and those identifying as multiple races who have a higher rate (11.5% and 10.5%) than white patients (8.1%). Conclusions SPC methodology allows clinicians to use EMR data to understand how patients' race effects their outcomes across a range of acute care domains. Enabling them to track the effect of system changes to understand if equity improves.