Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Dec 1982
Clinical Trial Controlled Clinical TrialEMLA--a eutectic mixture of local anaesthetics for topical anaesthesia.
A new topical anaesthetic formulation, EMLA, consisting of a eutectic mixture of the two local anaesthetics, prilocaine and lidocaine, was used in an attempt to reduce the pain associated with venous cannulation in children. The formulation of the local anaesthetic cream yields a high concentration (approximately 80%) of active substance compared with previous formulations (approximately 20%). ⋯ Stimulus of C fibre endings in the subcutaneous tissue and/or the vascular wall seems to be the mechanism behind the slight to moderate discomfort experienced by about one third of the children treated with EMLA. Local side effects of EMLA were negligible.
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Acta Anaesthesiol Scand · Dec 1982
Comparative StudyAttenuation of circulatory response to laryngoscopy and tracheal intubation: a comparison of two methods of topical anaesthesia.
Circulatory responses to laryngoscopy and endotracheal intubation were compared between three groups of patients, two of which were subjected to a procedure of topical anaesthesia before induction of general anaesthesia. Topical anaesthesia, achieved with either a lidocaine dose aerosol or by gargling with viscous lidocaine, attenuated the magnitude of the pressor response to laryngoscopy and intubation but had no effect on the heart rate response. Lidocaine aerosol had some advantages over viscous lidocaine; these were the significantly smaller haemodynamic response to the local anaesthetic procedure itself and probably shorter duration of the circulatory changes produced by intubation. It is concluded that both of these simple methods are relatively ineffective in preventing haemodynamic changes associated with laryngoscopy and intubation and should probably be combined with another preventive method.
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Acta Anaesthesiol Scand · Dec 1982
Comparative StudyA comparison of atropine and glycopyrrolate in anaesthetic practice.
The two anticholinergics, atropine and glycopyrrolate, were used for premedication and as an adjunct to reversal of residual neuromuscular block in a double-blind study. Glycopyrrolate, being about twice as potent as atropine in the clinical situation, was used in half the dosage of atropine. When used for premedication, no difference was found between the drugs concerning patients complaining of dry mouth, but more patients in the glycopyrrolate group had a gastric juice pH greater than 2.5 compared to the atropine group (not statistically different). ⋯ More patients in the atropine group had "excessive" oropharyngeal secretions (more than 2 ml) when extubated (P less than 0.05). The postoperative assessment showed little difference in the two groups, apart from a lower incidence of nausea and vomiting in the atropine group (not statistically different). The study shows that the use of glycopyrrolate was associated with a more stable cardiovascular system, fewer arrhythmias and superior control of oropharyngeal secretions at the time of reversal.
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Acta Anaesthesiol Scand · Dec 1982
Case Reports Randomized Controlled Trial Clinical Trialbeta-Receptor blockade and neurolept anaesthesia. Withdrawal vs continuation of long-term therapy in gall-bladder and carotid artery surgery.
Forty-eight chronically (greater than 3 months) beta-receptor-blocked patients with ischaemic heart disease and/or hypertension were studied on 49 occasions after random distribution to a 4-day, gradual preoperative withdrawal (n = 26) or a continuation (n = 23) of beta-receptor blockers. The patients were scheduled for either a cholecystectomy (n = 28) or a carotid thrombendarterectomy (n = 21) under neurolept anaesthesia. Three patients were excluded from the randomized part of the study due to complications (tachycardia, hypertension, severe angina) after therapy withdrawal. ⋯ Significantly more postoperative ECG changes (P less than 0.02) indicative of myocardial ischaemia were found than in beta-receptor blocked patients. These patients had low heart rates but also pronounced increases in pulmonary capillary wedge pressures, which in single patients could be associated with myocardial damage. These results imply that beta-receptor blockers should be continued before surgery and that a concomitant vasodilatatory therapy is likely to avoid the drawbacks of an increased cardiac afterload.