European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrapleural bupivacaine analgesia after thoraco-abdominal incision for oesophagectomy.
Intrapleural bupivacaine administration is said to produce good analgesia for the pain induced by a subcostal incision. However, reports of its efficacy after thoracotomy are conflicting. The goal of this study was to compare the analgesia produced by intrapleural administration of bupivacaine after oesophagectomy using a thoraco-abdominal incision with that obtained from intrapleural saline. ⋯ Plasma bupivacaine concentrations on Day 1 after the first intrapleural bupivacaine injection were less than 350 ng ml-1; on Day 4 after the last injection they were less than 1300 ng ml-1. In conclusion, intrapleural administration of bupivacaine produces effective analgesia after oesophagectomy performed with a thoracoabdominal incision. The technique is easy to perform and is safe.
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Fifty consecutive patients were studied prospectively to assess the effects of a continuous intravenous infusion of midazolam hydrochloride for sedation in patients requiring intensive care. Patient comfort was acceptable in all patients. However, to maintain the same degree of sedation it was necessary to increase the daily dose of midazolam indicating that benzodiazepine tolerance may have been developing. ⋯ Two patients with combined hepatic and renal failure took 124 and 140 h to awaken. Continuous intravenous infusion of midazolam offers good patient comfort but increasing dose requirements in critically ill patients may lead to drug accumulation and delayed awakening. The risks of cumulation may be increased if the drug is given by continuous infusion for prolonged periods without intermittent assessment of the patient's conscious state.
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Eighty-six patients completed a questionnaire about what they expected from a pre-operative visit by an anaesthesiologist. Ninety-one per cent of the patients wanted a detailed and informative conversation. The patient's previous knowledge stemmed primarily from lay sources, such as other patients and visitors. Age and marital status influenced the extent of the patient's previous knowledge.
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The accuracy of the Hemocue, a portable haemoglobinometer, was tested on 29 patients undergoing open-heart surgery, and the results were compared with the haemoglobin values obtained from the hospital laboratory. Special attention was paid to the lower range of haemoglobin values and the simplicity and speed of operating the meter. The correlation between the methods was good (r = 0.965). The limits of agreement were 0.0323 +/- 0.705 mmol l-1 (95% confidence level).
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SPINA is a program developed with LOTUS 1-2-3 that simulates the pharmacokinetics of an infusion of intravenous anaesthetic drugs. SPINA incorporates a database which contains records of multiple-compartment pharmacokinetic models. The models have been obtained from the literature. ⋯ To perform the pharmacokinetic simulation, the anaesthetist has to choose a pharmacokinetic model in which the program determines the turn-over rates, and displays a sequence of infusion steps. On request, SPINA provides the graphs for the theoretical drug distribution and for the infusion rate required to maintain the target concentration. SPINA therefore allows one to simulate the administration of intravenous anaesthetic drugs and to optimize their delivery.