RESUMEN
We have performed a randomized, cross over study in 22 children suffering from acute leukaemia, who underwent repeated anaesthesia for bone marrow aspiration and lumbar puncture. For their first anaesthetic, the children (aged 3-10 years old) received, either a thiopentone/isoflurane anaesthetic or intravenous propofol, both supplemented with nitrous oxide. On a second occasion they received the alternative technique. Of those children receiving thiopentone/isoflurane, 32% had significant coughing during anaesthesia, two progressing to laryngospasm requiring 100% oxygen. None of the patients receiving propofol had a respiratory disturbance (P = 0.016). 68% of the children preferred the propofol anaesthetic. Only one child in the thiopentone/isoflurane group preferred this technique. Twenty-seven per cent had no preference. There was no significant difference in length of anaesthetic time (P = 0.07) or the time taken for recovery (P = 0.17) between the two groups. There was a large individual variation in propofol requirements and movement was common during stimulation of patients in this group, though this did not adversely affect the surgical procedure.
Asunto(s)
Anestésicos Combinados , Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Isoflurano/administración & dosificación , Leucemia , Propofol/administración & dosificación , Tiopental/administración & dosificación , Enfermedad Aguda , Anestésicos por Inhalación/efectos adversos , Anestésicos Intravenosos/efectos adversos , Biopsia con Aguja , Médula Ósea/patología , Niño , Preescolar , Tos/inducido químicamente , Estudios Cruzados , Humanos , Isoflurano/efectos adversos , Laringismo/inducido químicamente , Leucemia/diagnóstico , Leucemia/terapia , Óxido Nitroso/administración & dosificación , Satisfacción del Paciente , Propofol/efectos adversos , Punción Espinal , Tiopental/efectos adversosAsunto(s)
Glucemia/análisis , Reanimación Cardiopulmonar , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Infarto del Miocardio/complicaciones , Anciano , Anciano de 80 o más Años , Automonitorización de la Glucosa Sanguínea , Capilares , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Reacciones Falso Negativas , Femenino , Paro Cardíaco/etiología , Paro Cardíaco/terapia , Humanos , Infarto del Miocardio/sangreRESUMEN
In a prospective study, 14 out of 49 patients presenting to a Regional Neurosurgical Unit with sudden headache suggestive of subarachnoid haemorrhage had normal CSF and a normal CT scan: it did not prove possible, on clinical grounds alone, to distinguish these from those that had bled. We have now followed all these patients for a minimum of 18 months. Only one has had no further headache, 4 have had musculoskeletal pain, 5 psychogenic pain, and 4 migraine type symptoms. None went on to have an unequivocal subarachnoid haemorrhage, and we conclude that angiography cannot be justified in patients with this type of "thunderclap headache".