European journal of anaesthesiology
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A questionnaire was sent to the pharmacies of 88 Finish hospitals with surgical departments to inquire about the consumption of opioids during 1990. Another questionnaire was sent to 480 members of the Finnish Society of Anaesthesiologists to ask how they administer opioids to adult patients. Answers were received from 95% of hospitals and 67% of anaesthetists. ⋯ Epidural opioids were administered by 77% of anaesthetists and patient-controlled analgesia (PCA) technique mostly for intravenous administration by 19%. Only 10% of Finnish anaesthetists were actively involved in the management of chronic pain; the methods they use are discussed. The majority of anaesthetists were satisfied with the currently available opioids.
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The influence of several intravenous anaesthetics on the heart was assessed using the isolated rat heart-lung preparation. Each group received 10(-3)mol litre-1 and 10(-4)mol liter-1 of ketamine, 6 micrograms ml-1 and 60 micrograms ml-1 of midazolam, 6 micrograms ml-1 and 60 micrograms ml-1 of diazepam or 0.6 micrograms ml-1 and 6 micrograms ml-1 of flunitrazepam. Systolic blood pressure in rats receiving high doses of midazolam, diazepam and ketamine were higher than that in the control group. ⋯ None of the intravenous anaesthetics, even in doses which were 100 times greater than therapeutic doses, showed any depressant effects in this preparation. Moreover, it is surprising that midazolam and diazepam produced direct increases in myocardial contractility. These results suggest that the cardiodepressant effects of intravenous anaesthetics may be due to their effects on the central nervous system.
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Randomized Controlled Trial Clinical Trial
Haemodynamic response to fibreoptic versus laryngoscopic nasotracheal intubation under total intravenous anaesthesia.
Thirty ASA physical status I and II patients scheduled for elective maxillofacial surgery received total intravenous anaesthesia with propofol, fentanyl and atracurium and were randomly allocated to undergo either fibreoptic or orthodox nasotracheal intubation. Haemodynamic responses to intubation were similar for both techniques. ⋯ There was no significant difference in the time required to complete intubation. SpO2 and end-tidal CO2 were similar for both techniques.
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Randomized Controlled Trial Comparative Study Clinical Trial
Metabolic response to lower abdominal surgery: analgesia by epidural blockade compared with intravenous opiate infusion.
To determine whether the type of peri-operative analgesic regimen affects the metabolic response during and after surgery, we studied 19 women undergoing abdominal hysterectomy under propofol anaesthesia. Patients were randomized to receive either continuous intravenous opioid or a bupivacaine-opioid mixture through a lumbar epidural catheter. Total body oxygen consumption and carbon dioxide excretion, blood glucose and haemodynamic variables were determined up to 24 h after surgery. ⋯ In the post-operative period, the increase in oxygen consumption up to pre-operative values, the urinary nitrogen excretion and the changes in acute phase proteins were similar in both treatment groups. In contrast, the respiratory quotient was significantly higher in the lumbar epidural group than in the intravenous opioid group, 0.87 (SD 0.04) vs 0.77 (SD 0.06) (P < 0.05) and the hyperglycaemic response was more delayed in the epidural group. These data suggest that prolonged sympathetic blockade associated with epidural analgesia might contribute to better preservation of glucose homeostasis in the perioperative period.
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The time profile of the neuromuscular block produced by a single bolus administration of vecuronium was simulated by a new model for the access of the relaxant to the receptors on the motor end plates. The receptors were assumed to be kinetically a part of the interstitial space of the muscle. ⋯ The model describes well the time lag needed to reach the peak submaximal block, its magnitude, as well as the time course of recovery from the maximal block. The limits of the model, evident in less than optimal simulation of the neuromuscular block by two doses of vecuronium in rapid succession, were attributed to the inadequate description of the vecuronium concentrations in plasma immediately after the bolus injection.