Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1987
Randomized Controlled Trial Clinical TrialThe effect of thoracic epidural analgesia on respiratory function after cholecystectomy.
To assess the effect of thoracic epidural analgesia (TEA) on postoperative respiratory function and pulmonary complications, a prospective randomized trial was conducted in patients undergoing cholecystectomy. One hundred patients were allocated to TEA (n = 30), TEA + general anesthesia (TEA + GA) (n = 30), or general anaesthesia (GA) (n = 40) groups. Respiratory function was analysed by measuring forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), functional residual capacity (FRC), total lung capacity (TLC), peak expiratory flow (PEF) in the supine and sitting postures, and arterial blood gases. ⋯ The preoperative difference of 27% in FRC between the sitting and supine postures was maintained after operation. PaO2 decreased by 0.8 kPa after TEA, by 1.5 kPa after TEA + GA with the lowest value on the 2nd postoperative day and by 1.5 kPa after GA, with the lowest value immediately after operation. Simultaneous hypercarbia indicated hypoventilation, which may have contributed to impaired respiratory function on the following days.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Oct 1987
Randomized Controlled Trial Comparative Study Clinical TrialPost-operative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III. The effects of per- and post-operative analgesia on morbidity.
One hundred and twenty-nine patients were subjected to three different types of thoracic operations. The patients were randomly allocated to balanced intravenous anaesthesia including i.v. nicomorphine during surgery and epidural nicomorphine post-operatively (epidural group, n = 58) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation and with post-operative intramuscular nicomorphine (intramuscular group, n = 71). Post-operative nicomorphine was only given at the request of the patients, and as frequently as needed to obtain satisfactory pain relief. ⋯ The requirements of nicomorphine over a period of 3 days were significantly lower in the epidural group 42 mg (s.d. = 18) versus 92 mg (s.d. = 33) in the intramuscular group. Significantly fewer pulmonary complications were observed in the epidural group: 7 atelectases compared to 27 in the intramuscular group. The epidural group showed no signs of ventilatory depression in spite of a catheter inserted at the T3-T4 level.
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Acta Anaesthesiol Scand · Oct 1987
Plasma concentrations of prilocaine and lidocaine and methaemoglobin formation in infants after epicutaneous application of a 5% lidocaine-prilocaine (EMLA).
The aim of the study was to measure the plasma levels of lidocaine and prilocaine after dermal application of EMLA in infants and to evaluate whether this procedure increases the levels of methaemoglobin (Met-Hb). Two groups of infants, 3-6 (n = 12) and 6-12 months (n = 10) of age, were studied. In total, 2 ml of EMLA was applied to 4 x 4 cm of skin surface for 4 h and blood samples for detection of Met-Hb and plasma levels of local anaesthetics were taken at 0, 2, 4 and 8 h after the application. ⋯ The plasma concentrations of lidocaine and prilocaine were in all cases below toxic levels and there were only minor increases in Met-Hb in a few infants. In conclusion, EMLA can be used safely in infants above 3 months of age provided that the recommendations with regard to dose, application area and time are followed. The use of EMLA in smaller infants and in children taking other Met-Hb-inducing drugs needs further evaluation.