Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1992
A new ventilator converter with the Siemens Servo Ventilator--evaluation in a lung model.
A ventilator converter device (Anmedic) for connecting a non-rebreathing ventilator (Servo Ventilator 900 B; Siemens-Elema) to a circle anaesthesia system was evaluated in a lung model. Recorded minute ventilation was slightly lower than dialled in most cases. We furthermore found inadequate expiratory expansion of the ventilator converter bellows, with progressive loss of tidal volume and consequently recorded minute volume, when fresh gas flow to the circle system was low (1 l.min-1), expiratory time was short (less than 40%) and respiratory obstruction was present.
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Acta Anaesthesiol Scand · Jan 1992
Randomized Controlled Trial Clinical TrialEpidural bupivacaine, sufentanil or the combination for post-thoracotomy pain.
Analgesia with epidural bupivacaine, sufentanil or the combination was studied in 50 patients who had undergone thoracotomy. During operation all patients received an initial dose of bupivacaine 0.5% with adrenaline 5 micrograms.ml-1 (5-10 ml) by thoracic epidural catheter. One hour later the patients were divided into three groups: the bupivacaine group (bupivacaine 0.125%), the sufentanil group (50 micrograms sufentanil in 60 ml normal saline) and the combination group (50 micrograms sufentanil in 60 ml bupivacaine 0.125%). ⋯ The sufentanil group had much better pain scores, but on exercise these patients experienced more pain than the combination group. The combination group had, overall, better pain scores. In the combination group, there were better respiratory results.
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Acta Anaesthesiol Scand · Jan 1992
Effect of continuous interscalene brachial plexus block on diaphragm motion and on ventilatory function.
Interscalene block may cause phrenic nerve block and decreased diaphragmatic motion. We evaluated the effect of continuous interscalene block on ventilatory function and diaphragmatic motion. We studied ten patients scheduled for surgery or manipulation of the shoulder. ⋯ In the other five patients, the amplitude of diaphragmatic motility on the side of the block was only 4-37% of the values before the block. All patients had a clear reduction in forced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and peak expiratory flow (PEF) 3 and 8 h after the block without signs of dyspnoea. In conclusion, in all our patients interscalene block caused an ipsilateral hemidiaphragm paresis, which in five of ten patients persisted until the end of the continuous block.
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In order to evaluate postoperative pain treatment following thoracic surgery, 214 medical records of patients who were operated during 1986-1988 were examined. Nurses' comments concerning pain and the amounts of analgesics given during the 2 postoperative days were recorded. The 150 patients who were still alive in December 1989 were sent a postal questionnaire which asked about the pain and the efficacy of pain relief they had received after their operation. ⋯ During the first postoperative week little pain was experienced by 60% of the patients, considerable pain by 35% and excruciating pain by 5% of the patients being interviewed. The postoperative pain relief was rated as good in 60% of the answers, satisfactory in 38% and poor in 2%. Persistent post-thoracotomy pain lasting for more than 6 months was reported by 44% of the patients, of whom 66% had received treatment for the pain.
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Acta Anaesthesiol Scand · Jan 1992
Pulmonary effects of body position, PEEP, and surfactant depletion in dogs.
The influence of position (sphinx, lateral, supine), surfactant depletion, and different positive end-expiratory pressure (PEEP) on functional residual capacity (FRC), series dead space (VdS) and compliance of the respiratory system (Crs) were evaluated in five dogs. Ventilation homogeneity as measured by an index (multiple breath alveolar mixing efficiency), oxygenation, and cardiovascular hemodynamics were additionally examined. The dogs were anesthetized with halothane, paralyzed, and mechanically ventilated. ⋯ Surfactant depletion by lung lavage with 37 degrees C saline caused an immediate and stable decrease in FRC, Crs, and oxygenation (P less than 0.05, respectively) for about 5 h without marked effects on the circulatory system. FRC and VdS increased with increasing PEEP. At the highest PEEP, 10 cmH2O (1 kPa), Crs decreased (P less than 0.05) and ventilation became more uneven, indicating alveolar overdistension.