Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1985
Circulatory changes during high thoracic epidural anaesthesia--influence of sympathetic block and of systemic effect of the local anaesthetic.
Circulatory changes during high thoracic epidural anaesthesia (TEA) were studied in nine healthy volunteers by means of echocardiography and systolic time intervals. The subjects also underwent a physical work test with bicycle ergometry. To evaluate the systemic effect of the local anaesthetic (bupivacaine), the same subjects were investigated 3 weeks later when a corresponding dose of the local anaesthetic was injected intramuscularly instead of epidurally. ⋯ Following i.m. injection of bupivacaine, SV decreased 8% and CO 20%. The pre-ejection period/left ventricular ejection time ratio increased 23% during TEA and 16% after i.m. injection. The results indicate that the circulatory changes did not seem to be caused entirely by the cardiac sympathetic block, but were due partly to the systemic effect of bupivacaine.
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Acta Anaesthesiol Scand · Nov 1985
Randomized Controlled Trial Comparative Study Clinical TrialA controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery.
A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low-dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4-S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P less than 0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. ⋯ Postoperative weight loss and decrease in serum-albumin and serum-transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self-aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the above-mentioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.
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Five dogs were cooled externally with ice-bags to rectal temperatures of 21.8-24.8 degrees C. Rewarming was performed with a specially constructed double-lumen oesophageal tube with circulating water at 42 degrees C. With this device, rewarming of the dogs to 30 degrees C took place in 60-102 min (mean 82 min). ⋯ The efficiency of this rewarming method is comparable to that of peritoneal dialysis. No after-drop in temperature was observed and there were no other complications during these experiments. Rewarming with an oesophageal thermal tube is very simple and safe to use.