Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1984
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of morphine and buprenorphine for analgesia after abdominal surgery.
Eighty fit adults having elective abdominal hysterectomy or cholecystectomy received buprenorphine or morphine intravenously at the start of peritoneal closure, in a randomised double-blind trial. The anaesthetic sequence precluded the use of other narcotic analgesics. Pain scores were lower in patients who received buprenorphine, as were the cumulative numbers of patients withdrawn from the trial at each interval because of pain, statistical significance being achieved at all intervals from one to seven hours after administration. ⋯ One patient with protracted drowsiness and slow respiratory rate after buprenorphine received naloxone. No serious side-effects were noted. Buprenorphine 4-6 micrograms/kg provided adequate postoperative analgesia of greater duration than could be achieved with morphine, and the potency of buprenorphine when administered in this way was at least 33 times that of morphine.
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Anaesth Intensive Care · Nov 1984
Comparative StudyManagement of fifty cases of chest injury with a regimen of epidural bupivacaine and morphine.
Epidural bupivacaine and morphine were administered to fifty patients who had suffered traumatic injuries to the chest. Forty-three of these patients made satisfactory recoveries without requiring any ventilatory support. ⋯ Serious side-effects were not common. One patient developed respiratory depression which required withdrawal of morphine, and one patient developed an epidural space infection.
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While some of the details of resuscitation of the bleeding patient remain contentious, the basic principles are clear. Adequate resuscitation implies the prompt restoration of tissue oxygenation by achievement and maintenance of airway patency, adequate ventilation, cardiac rhythm and intravascular volume. ⋯ The volume of fluid required for primary resuscitation varies and there is no well-defined endpoint against which to titrate fluid resuscitation. However, as the complications and mortality of shock are related to the degree and the duration of shock, definitive (usually surgical) intervention should be undertaken early if the clinical features of shock cannot be readily reversed or if the maintenance of clinically adequate perfusion cannot be achieved with the administration of less than 200 ml of fluid per hour.
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In this review blood component therapy for acute haemorrhage is summarised. As the haemotherapy is frequently the cornerstone of a successful outcome of haemorrhagic shock, attention to details in relation to the indications, safety and efficiency is essential. Massive blood transfusion brings with it many potential complications which may jeopardise a successful outcome for the patient after skillful medical and surgical care has controlled the basic problem.