Anesthesia and analgesia
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Anesthesia and analgesia · Nov 1996
The influence of lung volume reduction surgery on ventilatory mechanics in patients suffering from severe chronic obstructive pulmonary disease.
Recently, lung volume reduction [LVR] removal of about 20% of lung volume), has been performed to treat severe emphysema. Little is known, however, about the mechanism and time course of functional improvement, and the reasons that such patients can be tracheally extubated very early. Therefore, we studied changes in ventilatory mechanics in 12 patients after LVR. ⋯ All patients were successfully tracheally extubated within 5 h postoperatively. Immediately thereafter, a marked and sustained decrease in WOB, PEEPi, and Rawm was noted, as well as an increase in Cdyn. Ventilatory mechanics improved immediately after LVR, probably due to decompression of lung tissue, thereby enabling successful tracheal extubation.
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Anesthesia and analgesia · Nov 1996
Factors associated with hypotension and bradycardia after epidural blockade.
In order to identify patient-, anesthesia-, and surgery-related factors influencing the probability of hypotension and bradycardia after epidural blockade, an observational study was conducted on 1050 nonpregnant patients. Backward stepwise logistic regression was performed on the variables hypotension (systolic blood pressure < 90 mm Hg) and bradycardia (heart rate < or = 45 bpm). Hypotension and bradycardia occurred in 158 and 24 patients, respectively. ⋯ Sensitivity and specificity were 50% and 97%, respectively. In conclusion, our analysis can contribute to identification of patients at high risk to develop hypotension and bradycardia after epidural blockade. If bupivacaine instead of carbonated lidocaine is used and epidural fentanyl is not administered a decrease in the incidence of hypotension may be anticipated.
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Anesthesia and analgesia · Nov 1996
Thoracic epidural anesthesia improves functional recovery from myocardial stunning in conscious dogs.
The effects of thoracic epidural anesthesia (TEA) on the contractile performance of ischemic and postischemic myocardium have not been well investigated. The purpose of this investigation was to examine the effects of TEA on severity and duration of myocardial stunning in an experimental model for sublethal acute myocardial ischemia. Seven dogs were chronically instrumented for measurement of heart rate (HR), left atrial (LAP), aortic and left ventricular pressure (LVP), LV dP/dtmax' and myocardial wall-thickening fraction (WTF). ⋯ During ischemia neither the subendocardial/subepicardial nor the occluded/ normal zone blood flow was affected by TEA. TEA attenuates myocardial stunning in conscious dogs. This finding is consistent with data regarding a reduction of infarct size due to TEA.
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Anesthesia and analgesia · Nov 1996
Editorial CommentRegional anesthesia in children: what have we learned?