Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 1983
Combined high-frequency ventilation for management of terminal respiratory failure: a new technique.
Seven patients with severe adult respiratory distress syndrome (ARDS) developed terminal respiratory failure and severe hypoxemia (PaO2 below 50 mm Hg) with death imminent despite maximal ventilatory support with intermittent positive-pressure ventilation (IPPV) and positive end-expiratory pressure (PEEP). High-frequency positive-pressure ventilation (HFPPV) was used in these patients for one day at a rate of 250 breaths/min, with slight improvement of PaO2 to a mean of 80 mm Hg. High-frequency oscillatory (HFO) ventilation was used during the second day at a rate of 2000 breaths/min; this provided adequate oxygenation with a mean PaO2 of 244 mm Hg. ⋯ Moreover, CHFV was well tolerated in our patients, allowing them to communicate with their families and nurses. CHFV successfully treated the hypoxemia of respiratory failure in all the patients. However, five patients (71%) died of cardiac arrest as a result of multisystem failure despite adequate oxygenation (PaO2 above 80 mm Hg).
-
Anesthesia and analgesia · Jan 1983
Comparative StudyThe extent of blockade following various techniques of brachial plexus block.
The extent of sensory and motor blockades was examined in 195 patients 5 and 20 min after four different techniques of brachial plexus block using 50 ml of 0.5% bupivacaine. The interscalene technique of Winnie (N = 50) resulted in a preferential blockade of the caudad portions of the cervical plexus and the cephalad portions of the brachial plexus. The supraclavicular approach of Kulenkampff (N = 55) and the subclavian perivascular approach of Winnie (N = 56) each resulted in a homogeneous blockade of the nerves of the brachial plexus. ⋯ With all four techniques, motor blockade developed faster than sensory blockade. The difference in results suggests that the approach to be used should depend primarily upon the site of the operation. The perineural space enclosing the brachial plexus greatly facilitates the spread of a local anesthetic when injected; however, it is usually not filled completely or evenly.
-
Anesthesia and analgesia · Jan 1983
Attitudes of patients, housestaff, and nurses toward postoperative analgesic care.
A survey was carried out among housestaff and nurses involved with postoperative patient care to assess their knowledge of analgesics and their attitudes toward postoperative analgesic care. Only one-fifth of the respondents prescribed for complete pain relief. There were some misconceptions about adding other drugs to narcotic analgesics as well as fear of the addictive properties of these narcotics. ⋯ Seventy-five percent of the patients reported that their overall postoperative pain relief had been adequate. There was no correlation between the amount of analgesic required postoperatively and either the degree to which patients believed pain builds character or the degree to which they rated themselves sensitive to pain. This study emphasizes the need for better and more comprehensive training of housestaff and nurses in analgesic care.