Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 1984
Effect of epidural morphine on post-operative pulmonary dysfunction.
The effect of post-operative epidural morphine analgesia on pulmonary function was assessed after abdominal surgery and compared to conventional analgesia. In a control group, ten patients received a parenteral analgesic, non-narcotic drug. In a second group of 11 patients, epidural morphine was injected after the operation and continuous analgesia was prolonged until the 3rd post-operative day by means of repeated injections through an epidural catheter. ⋯ Pain scoring documented a better analgesia in the epidural group during the post-operative period. By contrast, epidural morphine was unable significantly to improve VC, FEV1 and FRC during the post-operative course. The results suggest that pain is not an important factor of decreased post-operative pulmonary function.
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Acta Anaesthesiol Scand · Apr 1984
Randomized Controlled Trial Comparative Study Clinical TrialFailure of epidural analgesia to modify postoperative depression of delayed hypersensitivity.
Delayed hypersensitivity to four common antigens was assessed in 32 patients undergoing major abdominal surgery randomly allocated to either general anesthesia (fentanyl + O2/N2O + postoperative pain relief with systemic opiates) or general anaesthesia + epidural analgesia (local anaesthetics + morphine) continued for 72 h. Skin-test responses were performed 2 days before surgery and 1 day after surgery and compared to a similar retesting schedule in 16 comparable non-operative control patients. ⋯ In contrast, mean skin-test responses in patients operated during general anaesthesia + systemic opiates for postoperative pain relief fell from 1422 to 1227 mm2 (P = 0.3) and in patients receiving epidural analgesia from 1228 to 890 mm2 (P = 0.06), without statistically significant differences between these two groups (P greater than 0.5). Thus, surgery leads to depression of delayed hypersensitivity and this impairment in immunofunction is not modified by an epidural analgesic regimen providing adequate pain relief.
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Acta Anaesthesiol Scand · Apr 1984
Comparative StudyPain relief with epidural buprenorphine after spinal fusion: a comparison with intramuscular morphine.
In a prospective randomized trial, epidural buprenorphine was compared with intramuscular morphine for pain relief after spinal corrective surgery. Both forms of analgesia were given on demand and both produced excellent reduction of pain as assessed with visual linear analogue. The quality and duration of analgesia were similar for both groups of patients. Since the correct placement of epidural catheters could be done intraoperatively in difficult cases and since many patients for spinal corrective surgery have limited respiratory reserve, the authors feel that epidural buprenorphine provides an excellent alternative to conventional opiate analgesia after this type of surgery.
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Acta Anaesthesiol Scand · Apr 1984
Effects of venous air embolism on the cardiovascular system and acid base balance in the presence and absence of nitrous oxide.
Cardiovascular responses and acid-base changes with graded volumes of intravenously injected air were measured in dogs anesthesized with pentobarbital and either 100% oxygen or 50% oxygen and nitrous oxide. Mean arterial blood pressure decreased significantly with 2.5 ml of air/kg in the oxygen group and at all volumes in the nitrous oxide group. The volume of air embolus appeared to increase more than twice in the presence of 50% nitrous oxide. ⋯ Right atrial pressure increased while left atrial pressure decreased significantly in both groups. With injected volumes of 2.0 and 2.5 ml or air/kg, right atrial pressure exceeded left atrial pressure creating the potential of paradoxical air embolism. The pH and PaO2 decreased while PaCO2 increased significantly during air embolization.
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Acta Anaesthesiol Scand · Apr 1984
Case ReportsBradycardia and cardiac asystole following a single injection of suxamethonium.
Twenty cases of severe bradycardia, including 12 cases of cardiac asystole, following administration of a single dose of suxamethonium to 17 adult patients are presented. Treatment consisted of i.v. atropine in 16 cases, and in four cases external cardiac massage or a precordial thump was also given. ⋯ The mechanism is not known, but it is suggested that i.v. administration of fentanyl at induction may enhance the tendency to bradycardia following suxamethonium. Absence of preoperative atropine may also be of importance.