Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 1991
Randomized Controlled Trial Comparative Study Clinical TrialComparison of ephedrine and etilefrine for the treatment of arterial hypotension during spinal anaesthesia in elderly patients.
Thirty ASA II-III patients (greater than 65 years) undergoing hip surgery under bupivacaine spinal anaesthesia, and presenting a 25% reduction in mean arterial pressure (MAP), were included in the study. The patients were randomly allocated to receive, under double-blind conditions, either ephedrine 0.07 mg kg-1 or etilefrine 0.03 mg kg-1 boluses i.v. when MAP decreased by 25% from the preanaesthetic reference value. ⋯ The increases in systolic arterial pressure (SAP) and heart rate were similar in both groups. The administration of repeated doses of either sympathomimetic showed the same tendency to increase SAP, DAP, and MAP values as the first dose.
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Acta Anaesthesiol Scand · Feb 1991
Case ReportsSpinal epidural hematoma following epidural anesthesia versus spontaneous spinal subdural hematoma. Two case reports.
Two cases of lumbar hemorrhage with subsequent persistent neurologic sequelae are presented and their possible causes are discussed in the context of a literature review: one patient with spontaneous spinal subdural hematoma with no trauma or lumbar puncture and one with spinal epidural hematoma associated with preceding epidural catheterization for postoperative pain relief. The subdural hematoma was associated with a thrombocytopenia of about 90,000/microliters due to intraoperative blood loss. ⋯ In conclusion, the reasons for both hematoma remain unclear. With regard to the epidural hematoma and low-dose heparinization, the possible coincidence of spontaneous lumbar hematoma and lumbar regional block should be taken into consideration.
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Acta Anaesthesiol Scand · Feb 1991
Isocapnic high frequency jet ventilation: dead space depends on frequency, inspiratory time and entrainment.
Twelve healthy pigs were ventilated with high frequency jet ventilation via a Mallinckrodt HiLo jet tube. The expired gas was led to a conventional ventilator and CO2 analyzer which were used to measure CO2 elimination. There was no bias flow, so that the jet entrained only expired gas, i.e. rebreathing occurred. ⋯ Both increasing frequency at a constant Ti/Ttot, and increasing Ti/Ttot at a constant frequency, increased VD/VT which was maximal (0.8) at 11 Hz and a Ti/Ttot of 20%. When entrainment was blocked, tidal jet volume had to be greatly increased. The continuous measurement of CO2 elimination was found to be useful for maintaining isocapnia when the jet ventilator setting was changed.
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Acta Anaesthesiol Scand · Feb 1991
Randomized Controlled Trial Clinical TrialEffects of interpleurally administered bupivacaine 0.5% on opioid analgesic requirements and endocrine response during and after cholecystectomy: a randomized double-blind controlled study.
In 30 patients undergoing cholecystectomy, a randomized double-blind saline-controlled study was performed using interpleural 0.5% bupivacaine with or without epinephrine (5 micrograms.ml-1) in combination with 0.8% halothane inspired concentration in oxygen. The aim of the study was to investigate whether interpleural 0.5% bupivacaine could decrease the intraoperative opioid requirements and attenuate the metabolic endocrine response to surgical stress. Patients were randomly allocated to one of three groups: Group 1: 0.5% bupivacaine; Group 2: 0.5% bupivacaine with epinephrine (5 micrograms.ml-1); and Group 3: saline. ⋯ In the saline group seven out of ten patients needed additional analgesics (P less than 0.05). Cortisol levels increased in response to surgery in all groups: maximum levels in Groups 1, 2 and 3 were: 1.09 +/- 0.29, 1.11 +/- 0.20 and 1.19 +/- 0.16 mumol.l-1, respectively. Plasma glucose concentrations increased significantly in all groups: maximum levels in Groups 1, 2 and 3 were: 7.6 +/- 1.3, 7.3 +/- 1.7 and 8.3 +/- 1.7 mmol.l-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Feb 1991
Maternal and fetal plasma atrial natriuretic peptide concentrations during elective caesarean section.
Atrial natriuretic peptide (ANP) is stored in the atrial cardiocyte and is capable of exerting potent, selective, and transient effects on fluid and electrolyte balance and on blood pressure. Because fluid shifts and hemodynamic adjustments occur during parturition, ANP might play a homeostatic role in the parturient and fetoplacental unit. We measured maternal and fetal plasma ANP concentrations in 19 parturients during elective caesarean section. ⋯ There was a significant correlation between the volume of maternal Ringer's lactate infusion received and maternal ANP concentration. A significant correlation was seen between the total dose of ephedrine administered acutely prior to delivery and the UA ANP concentration. These data suggest that: 1) increased blood volume during pregnancy is associated with increased maternal plasma ANP levels, and 2) the fetus can produce its own ANP, and is thereby capable of responding to ANP stimulating factors.