Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Dec 1984
Randomized Controlled Trial Comparative Study Clinical TrialComparison of intramuscular analgesia, intercostal block, epidural morphine and on-demand-i.v.-fentanyl in the control of pain after upper abdominal surgery.
Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups according to the postoperative pain treatment. All patients had a standardized balanced anaesthesia and for postoperative analgesia either intramuscular oxycodone and/or metamizol (IM), intercostal block with 0.5% bupivacaine (IC), epidurally 4 mg morphine (EM) or i.v. infusion of fentanyl 0.54-0.99 micrograms min-1 + on-demand boluses of 7.2-13.5 micrograms (ODAC) were given. The pain intensity 2 h postoperatively was similar in all groups, mean score ranging from 3.2-4.3 on a scale from 0-10. ⋯ The amount of fentanyl infused in 24 h to the ODAC patients varied considerably, 814-2233 micrograms, as did the number of on-demand boluses, 3-155. At 24 h, an efficacy rating "good" was distributed as follows: IM 9/20, IC 11/20, EM 11/20 and ODAC 13/20. In the whole patient material 92.5% rated their condition as "good" or "fair".
-
Acta Anaesthesiol Scand · Dec 1984
Comparative StudyHydroxyethyl starches, dextran and balanced salt solution in correction of hypotension during epidural anaesthesia.
A low molecular weight (Mw 38 000) and a medium molecular weight (Mw 125 000) hydroxyethyl starch and a medium molecular weight dextran (Mw 70 000) solution were compared with a balanced salt solution in 123 patients undergoing operations of the lower extremities in epidural anaesthesia; 500 ml of the studied solutions were infused during 15 min after the injection of the epidural anaesthetic. The need for etilefrine hydrochloride as a vasoconstrictor in correcting hypotensive reactions was recorded. Changes in haemoglobin (Hb), haematocrit (Hct), serum total protein and serum albumin concentrations were measured. ⋯ The fall in blood pressure cannot be totally inhibited by administration of 500 ml plasma substitute. According to the differences in Hb, Hct, serum protein and albumin values, the hydroxyethyl starch solutions were significantly more effective plasma substitutes than the balanced salt solution and as effective as dextran. No side-effects attributable to the solutions used were observed.
-
Acta Anaesthesiol Scand · Dec 1984
Natural killer cell activity in patients undergoing upper abdominal surgery: relationship to the endocrine stress response.
Natural killer (NK) cell activity and the endocrine response during and after parietal cell vagotomy were studied in two groups of patients receiving either epidural analgesia extending from S5 to Th4 + general anaesthesia (Group I), or general anaesthesia (Group II). NK cell activity of unseparated mononuclear cells in peripheral blood was measured against K-562 target cells in a 51Cr-release assay. NK cell activity increased in the same way in both groups in relation to premedication, anaesthesia and surgery (P less than 0.01). ⋯ A significant increase in plasma adrenaline and serum prolactin was found in both groups during anaesthesia and surgery. The findings indicate that NK cell activity during upper abdominal surgery is modified in almost the same way during two different anaesthetic techniques, one of which partly seemed to block the endocrine surgical stress response. The fluctuations in NK cell activity were not correlated to the changes measured in hormone concentrations.
-
Acta Anaesthesiol Scand · Dec 1984
Comparative StudyThe measurement of tidal volumes in spontaneously breathing children during general anaesthesia using a Haloscale infant Wright respirometer.
The accuracy of tidal volume measurements made with a Wright Haloscale infant respirometer in children breathing spontaneously during general anaesthesia was assessed by a bench test. The tidal volumes and peak flow rates of 20 spontaneously breathing, anaesthetised children were measured with a pneumotachograph before and during surgery, and similar volumes, at the same flow rates, were delivered by a calibrated syringe simultaneously to the respirometer and a pneumotachograph. The results reveal that the mean (+/- s.d.) peak gas flow rates of children aged 6 years and less, 7.5 (+/- 1.6) and 9.3 (+/- 0.1) l/min before surgery and during surgery respectively, are significantly less than the peak flow rates, 11.3 (+/- 1.0) and 11.9 (+/- 1.5) before and during surgery, respectively, of children aged more than 6 years; and that the respirometer underestimates tidal volume by 10% when the peak flow rate is 11 l/min, and the percentage error in tidal volume estimation by the respirometer increases as the peak gas flow declines below 10 l/min.