Ugeskrift for laeger
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In perioperative hypothermia, a central temperature of less than 36 degrees C develops in connection with anaesthesia and operation. Perioperative hypothermia constitutes a daily problem which results in increased morbidity and mortality in risk groups. The influence of anaesthetic agents on temperature regulation is reviewed. ⋯ The risk groups and prophylactic methods for hypothermia are mentioned. Higher temperatures in the anaesthetic room, prewarming of infusion fluids and employment of infusion warmers should be employed with all anaesthetics. In patients in risk groups, extensive employment of combined methods of prevention of hypothermia is recommended.
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An investigation was performed to compare the Animec infusion warmer with the Fenwall infusion warmer. The maximal increase in temperature for the Animec infusion warmer was 8.9 degrees C and this was recorded with a flow of 395 ml/hour. The values for the Fenwall infusion warmer were 12.0 degrees C with a flow of 1,527 ml/hour. ⋯ It is concluded that supply of energy to the infusion warmers. It is concluded that supply of energy to the infusion fluid depends on the flow of fluid through the infusion warmer and the capacity of the infusion warmer. Great differences were observed in the capacities of the two infusion warmers to compensate for the peroperative energy deficit at the rates of flow normally recommended.
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An arrangement is described in which the general practitioners on duty participate in the ambulance service and the prehospital treatment of acutely ill patients. This arrangement has been followed prospectively for one year and was utilized in 141 cases. ⋯ It is concluded that this arrangement is feasable as a means of improving the prehospital treatment of acutely ill patients but that it should be supplemented by increased efforts in training the population in resuscitation. In addition, it is concluded that the function of the alarm central was not optimal as half of the alarms came via the doctor on duty instead.
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The three main nerves from the lumbar plexus may be blocked by injection of local anesthetic into the facial envelope of the femoral nerve ("three-in-one block"). The femoral nerve may be localized by obtaining paresthesia, by employing a nerve stimulator or by the loss of resistance technique. ⋯ The "three-in-one block" may be employed for immediately pain relief of pain and for treatment of postoperative pain from fractures in the hip, femur and knee. Introduction of a catheter into the femoral nerve sheath is recommended to provide continuous block of the lumbar plexus for relief of postoperative pain.
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Ugeskrift for laeger · May 1990
Review[Urinary retention in connection with postoperative pain treatment with epidural opioids].
The incidence of retention of urine in cases of postoperative epidural opioid analgesia varies from 15% to 90%. The extent to which this phenomenon depends upon the dosage employed has not been elucidated. The cause of postoperative retention of urine (PU) is probably a combination of the central and peripheral effect of the opiate involving altered autonomic activity. ⋯ Carbacholine is not effective in the treatment of postoperative retention of urine. In animal experimental studies, kappa-receptor agonists have an analgesic effect without urodynamic side-effects but no clinical trials on man have hitherto been undertaken. When postoperative retention of urine occurs after epidural opioid treatment, clean intermittent catheterization or introduction of a thin suprapubic catheter are recommended.