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11
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:
Britton J.T., Hannallah R.S., Schafer P.G., Norden J.M. Comparison of induction and recovery characteristics of propofol, thiopental and halotane in children / YCanadian J. ofAnaesth.1991. 38 (Suppi): A 146.
Coates D.P. Experience with propofol in outpatient surgery // New Horizonts in Anaesthesia: Focus on Propofol. Toronto: MES Medical Education Services.1989. P.27 33.
Davison J.K., Eckhardt III W.F., Perese D.A. Clinical Anesthesia Procedures of the Massachusetts General Hospital, 4-th Edition.1993. 711 p.
Deramoudt V., Gaudon M., Malledant Y. et al. Effect of propofol on intraocular pressure during paediatric squint surgery//Ann. Francaises d'Anesthesie et de Reanimation, 1990.9.P. 15.
Glen J.B. Interactions between intravenous anaestetic agents and suxamethonium in mice//Br. J. of Pharmacology.1977.V. 61.P. 487.
Glen J.B. Animal studies of the anaesthetic activity of ICI 35,868// Br.J. ofAnaesth., 1980, 52, p 73146.
Glen J.B. and Hunter S.C. Pharmacology of an emulsion formulation of ICI 35,868//Br.J. of Anaesthesia.1984a.V. 56.P. 617626.
Glen J.B., Hunter S.C. et al. Interaction studies and other investigation of the pharmacology of propofol (Diprivan)//Postgraduate Medical J. 1985V. 61P. 714.
Grounds R.M., Moore M., Morgan M. The relative potencies of thiopentone and propofol//European J. of Anaesthesiology.1986.V. 3. P. 1117.
Kallar S.K., Everett L.L. Desflurane versus propofol for outpatient laparoscopic surgery//Anesthesiology.1991.V. 75.A.9.
Koch E., Treede R.D., Schulte am Esch J., Bromm B. Modulation of Pain-Related Somatosensory Evoked Potentials by General Anesthesia//Anesth. Analg., 1990.V 71.P. 225230.
Ramani R. et al. Dose-related changes in CBF and CMR02 during infusions in rabbits Rapp S.E., Conahan T.J., Pavlin D.J. et al. A comparison ofdesflurane with //Anaesth.1990V. 73-A.P. 703.
Rapp S.E. Conahan T.J., Pavlin D.J. at al. A comparision of desflurane with propofol in outpatients undergoing peripheral orthopedic surgery// Anesthesiology.1991.V. 75.A. 12.
Roily G., Versichelen L., Herregods L. Cumulative experience with propofol (Diprivan) as an agent for the induction and maintenance of anaesthesia//Postgraduate Medical J.1985.V. 61 (S.3).P. 96100.
Sung Y.F., Reis N., Tillette T. The differential cost of anesthesia and recovery with propofol-nitrous oxide anesthesia versus thiopental-isoflurane-nitrous oxide//Anesth. Anal.1990.V. 70 (S).P. 396.
Sung Y.F., Reis N., Tillette T. The differential cost of anesthesia and recovery with propofol-nitrous oxide anesthesia versus thiopental sodium-isoflurane-nitrous oxide anesthesia//}.Clin. Anesth.1991. V. 3.P. 391394.
Van Hemelriyck J. et al. Effects of propofol on cerebral circulation and autoregulation in the babooiV/Anesth. and Analg.1990.V. 71. P. 4954.
Varner P.D. et al. Survival during severe hypoxia and propofol or ketamine anaesthesia in mice.//Anesth., 1988.V. 69, A 571.
Werner ., Hoffman W.E., Kochs E. Effect of propofol on cerebral and spinal cord blood flow autoregulation in rats.//Anesthesiology. 1990.A.V. 73P. 556.
Wrigley S.R., Fairfield J.E., Jones R.M., Black A.E. Introduction and recovery characteristics of desflurane in day case patients: a comparison with propofol.//Anaesth.1991.V. 46.P. 615622.
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