Acta anaesthesiologica Scandinavica
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The adverse effects of pain on acutely ill or traumatized patients are well documented. A variety of pain-relieving techniques are now available to meet the varied requirements for pain relief. ⋯ The block proved quick and simple to perform, with excellent clinical results of long duration and virtually no complications. Although not previously described, this single, large-volume injection approach to achieving an extensive thoracic paravertebral block may well become an important pain management technique in appropriate patients.
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Acta Anaesthesiol Scand · Feb 1989
Comparative StudyEarly detection of inadvertent oesophageal intubation: pulse oximetry vs. capnography.
The aim of our retrospective study was to evaluate the efficacy of routine pulse oximetry and capnometry for detection of oesophageal tube misplacement. Patients undergoing ENT interventions at our hospital are routinely monitored by ECG, arterial blood pressure by cuff, capnography, and pulse oximetry. Beat-to-beat values of Sao2 and CO2 waveform were recorded by a graphic printer connected to a microcomputer, ASA I patients were routinely preventilated with FIO2 = 0.3, and ASA II-III patients with FIO2 = 1.0. ⋯ Oesophageal misplacement was detectable within 7.5 +/- 0.9 s in patients preventilated with FIO2 = 0.3 due to a 2.1 +/- 0.8% decrease in Sao2 (P less than 0.001). Our results underscore the significance of capnometry for rapid detection of inadvertent oesophageal intubation. High-resolution pulse oximetry is a valuable supplement but not a substitute for capnometry.
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Acta Anaesthesiol Scand · Feb 1989
Comparative StudyCardiotoxicity of ropivacaine--a new amide local anaesthetic agent.
Anaesthetically equipotent doses of lidocaine, bupivacaine and a new bupivacaine-like local anaesthetic agent, ropivacaine, were injected into the left anterior descending coronary artery of pentobarbital-anaesthetized pigs. The aim was to study the cardiotoxicity of ropivacaine in relation to the two other drugs. A random, crossover, dose response study design was used. ⋯ Comparable prolongation of the QRS-interval was recorded after 2 mg of bupivacaine, 4.5 mg of ropivacaine and 30 mg of lidocaine. Thus, the electrophysiological toxicity ratio was 15:6.7:1 (B:R:L). Provided local anaesthetic potency data can be extrapolated from the isolated nerve preparation to regional anaesthesia in humans, ropivacaine appears to provide a greater margin of safety than bupivacaine, if inadvertently injected into the venous circulation.
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Acta Anaesthesiol Scand · Feb 1989
Early detection of the TUR syndrome by marking the irrigating fluid with 1% ethanol.
The ethanol concentration in the expired breath (EB-ethanol), the volumetric fluid balance and the serum sodium concentration were measured in the course of 60 transurethral resections of the prostate in which the irrigating fluid was 1.5% glycine + 1% ethanol. Measurement of EB-ethanol indicated absorption of irrigant at a rate of more than 150 ml in 10 min, as measured volumetrically. There was a significant direct linear relationship between EB-ethanol and the cumulative volume of irrigant absorbed (R2 = 0.83); this correlation was stronger when the duration of absorption was taken into account (R2 = 0.90). ⋯ Symptoms that are recognized components of the TUR syndrome developed in 8 of the 13 patients absorbing more than 11 of irrigant, while the ethanol exerted no adverse effects. The results of the study indicate that 1% ethanol is a suitable marker for monitoring irrigant absorption by means of the expired breath test in routine transurethral surgery. At this concentration the sensitivity of the test is adequate for detecting absorption, while the ethanol is less toxic than the irrigant fluid itself.
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Acta Anaesthesiol Scand · Feb 1989
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialTreatment of post-thoracotomy pain with intermittent instillations of intrapleural bupivacaine.
The effect of intrapleural bupivacaine in the treatment of post-thoracotomy pain was evaluated. Bupivacaine, 0.5% 20 ml, with adrenaline (5 micrograms/ml) was given through an indwelling intrapleural catheter, at 4-h intervals four times daily for 2 days. No pleural suction was applied during and 10 min after each injection. ⋯ The VAS and PQ scores 30 min after bupivacaine instillations diminished to an extent similar to that after oxycodone treatment. The need for analgesics during the day of operation was less in the bupivacaine group than in the control group (P less than 0.001). The number of oxycodone supplementation doses during 48 h postoperatively was, however, not smaller in the bupivacaine group than in the control group.