Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1984
Continuous axillary brachial plexus block--a clinical and anatomical study.
In order to decrease both the failure rate and inadvertent arterial puncture rate that may be associated with continuous axillary brachial plexus block, a new technique of insertion of the catheter in the axilla was studied in 52 patients and in 12 fresh cadavers. With the arm abducted, externally rotated, and flexed at the elbow, an 80-mm long catheter was inserted under the skin at a site located 40-mm below the axilla and medial to the biceps muscle. Injection of lidocaine and bupivacaine produced sensory and motor blockades of the median, radial, ulnar, and musculocutaneous nerves in 98% of the patients. ⋯ In the anatomical study, injection of dye and molding solutions showed that the tip of the catheter lay not in the perivascular sheath, but in a virtual cavity that was very superficial, under the skin, and surrounding the perivascular space. The technique used was safe and had a high success rate. It is particularly useful in patients undergoing long operations and in patients in whom pain would otherwise prevent postoperative physiotherapy of the upper arm.
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In order to evaluate the possible physiologic significance of intra- and postoperative hypotension, we monitored arterial blood pressure and heart rate continuously for 36 hr starting the night before and ending the morning after operation in 34 gynecologic patients. The lowest pressures that occurred during physiologic sleep were compared with the lowest arterial pressures that occurred during anesthesia without deliberate hypotension. ⋯ These physiologic nadirs in blood pressure are assumed to be tolerated well by the patient. Intraoperative pressures in elderly patients frequently drifted below sleep-associated levels of blood pressure and may, therefore, constitute physiologically significant hypotension.
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Anesthesia and analgesia · Jun 1984
Comparative StudyComparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function.
In a randomized double-blind study of thirty grossly obese patients undergoing gastroplasty for weight reduction, the effects of intramuscular and epidural morphine were compared as regards analgesia, ambulation, gastrointestinal motility, early and late pulmonary function, duration of hospitalization, and occurrence of deep vein thrombosis in the postoperative period. The patients were operated on under thoracic epidural block combined with light endotracheal anesthesia. A six-grade scale was devised to quantify postoperative mobilization. ⋯ Furthermore, earlier postoperative recovery of peak expiratory flow and bowel function presumably contributed to a significantly shorter hospitalization in patients receiving epidural morphine. There was no evidence of prolonged respiratory depression in this high-risk category of patients. The 99mTc -plasmin tests revealed no significant difference between the two groups.
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Anesthesia and analgesia · Jun 1984
The pall ultipor breathing circuit filter--an efficient heat and moisture exchanger.
The Pall bacterial filter was tested as a potential heat and moisture exchanger on a model patient, placed on a circle absorber system, and clinically. The laboratory study was conducted during mechanical ventilation at a V of 6 L/min with fresh gas inflows of 1, 3 and 6 L/min. The model patient introduced carbon dioxide into the circuitry at a rate of 200 ml/min. ⋯ The clinical study was conducted on ten adult anesthetized patients breathing through the bacterial filter and ten controls. The loss of body temperature was 0.2 degrees C when the filter was used and 1.5 degrees C when the filter was not used. Arterial blood gas tensions were within normal limits when the bacterial filter was used as a humidifier.