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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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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We used three methods to determine the onset of rebreathing in the Ohmeda enclosed afferent reservoir breathing system and compared the results with the previously published rebreathing characteristics of this system. Of the methods studied, expiratory limb capnography proved unsuitable for determining the onset of rebreathing in this system. Inspiratory limb capnography and minimum inspired carbon dioxide at the mouth did enable the onset of rebreathing to be determined. However the fresh gas flow:minute volume ratio at which rebreathing occurred as determined by these criteria was less than that determined by the Kain and Nunn criteria and thus offer no clinical advantage over the latter.
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41 patients (ASA I-II) were intubated using a new device for blind oral intubation (Augustine Guide). A group of 33 consecutive patients (Mallampati I and II), was studied for routine intubation. Another group of eight patients (Mallampati III and IV) was selected to study the guide in difficult airway management. ⋯ The Augustine Guide proved to be helpful to intubating patients with an anterior larynx and receding mandible. However, blind oral intubation attempts required a median duration of 65 s (range 35-90 s). Patients with a low Mallampati score did not benefit from the new device.