Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1992
ReviewLow molecular weight heparin for thromboprophylaxis and epidural/spinal anaesthesia--is there a risk?
This article reviews the problem of bleeding in connection with epidural/spinal anaesthesia, with special emphasis on the use of low molecular weight heparins for thromboprophylaxis. There are methodological difficulties to studying the problem in a scientifically correct way because of the rarity of the complication. ⋯ So far, there is only a single case report, of spinal haematoma, although low molecular weight heparins have been used in combination with epidural/spinal anaesthesia in at least 1,000,000 patients. In controlled studies, at least 10,000 patients have been given the combination without complications.
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical TrialLidocaine hydrocarbonate and lidocaine hydrochloride for cesarean section: transplacental passage and neonatal effects.
Twenty-six patients, ASA physical status 1, scheduled for elective cesarean section, were divided at random into two groups and received via an epidural catheter 20 ml of 2.2% lidocaine hydrocarbonate (17.3 mg.ml-1 lidocaine base) with 5 micrograms.ml-1 epinephrine freshly added (Group CO2 = 13 patients) or 20 ml of 2% lidocaine hydrochloride (17.3 mg.ml-1 lidocaine base) also with 5 micrograms.ml-1 epinephrine freshly added. Following clampage of the umbilical cord (at 40.1 +/- 4.9 min after the injection of lidocaine for the CO2 group and at 41.0 +/- 5.4 min for the HCl group), serum concentrations of lidocaine were measured both in the mother and in the umbilical vein. ⋯ The ratio of umbilical vein to maternal vein concentrations of lidocaine was also similar in both groups: 0.45 +/- 0.07 for the CO2 group vs 0.54 +/- 0.24 for the HCl group. The percentage of newborns with a normal NACS (score > or = 35/40) was equal in both groups, i.e. 91% at 15 min and 2 h of life and 100% at 24 h of life.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical TrialIncreased volume of gastric contents in diabetic patients undergoing renal transplantation: lack of effect with cisapride.
Gastroparesis is a frequently unrecognized complication of insulin-dependent diabetes mellitus, which subjects these patients to the risk of aspiration at induction of anaesthesia. The effect of oral cisapride on volume and pH of gastric contents was studied in 24 diabetic and 24 non-diabetic uraemic patients undergoing renal transplantation. All patients were allocated randomly in a double-blind fashion to receive either 10 mg of cisapride or placebo orally approximately 100 min before anaesthesia and three times daily for the first 2 postoperative days. ⋯ Cisapride lacked effect on gastric contents and postoperative gastrointestinal motility. Diabetic uraemic patients had larger gastric volumes than their non-diabetic controls at induction of anaesthesia. Cisapride had no effect on gastric emptying preoperatively nor on postoperative bowel function.
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical TrialThiopentone or propofol for induction of isoflurane-based anaesthesia for ambulatory surgery?
This study compares psychomotor recovery following induction of anaesthesia with either thiopentone or propofol in 30 healthy, unpremedicated patients undergoing outpatient arthroscopic procedures of the knee. A battery of tests including simple reaction time (SRT), choice reaction time (CRT), perceptive accuracy test (PAT) and digit symbol substitution test (DSST) were done before anaesthesia. The patients were randomly divided into two groups: Group 1 was induced with thiopentone 5-6 mg/kg while Group 2 was induced with propofol 2-3 mg/kg. ⋯ The SRT, CRT and DSST proved to be relatively insensitive in the detection of residual effects of anaesthesia and had a significant learning effect. This study suggests that induction of anaesthesia with propofol followed by maintenance with isoflurane in oxygen and air during spontaneous ventilation is associated with rapid psychomotor recovery and is a suitable method for ambulatory surgery. The PAT is sensitive and not associated with some of the problems found with other commonly used tests.
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Acta Anaesthesiol Scand · Oct 1992
Anaesthetic uptake and washout characteristics of patient circuit tubing with special regard to current decontamination techniques.
The amounts of halothane and isoflurane trapped after exposure for up to 3 h at 2 MAC in commonly used anaesthesia circuit tubing were quantitated by gas chromatography. The decontaminating effects of procedures such as flushing with oxygen, thermal disinfection and/or routine storage were assessed in a similar way. After halothane exposure, anaesthetic content was highest in silicone (398 +/- 55 mg 100 g-1). ⋯ Twenty-minute flushing with oxygen (8 l min-1) decreased effluent gas concentrations below 5 p.p.m. in all tubings. With silicone, after 1 h flushing, halothane concentrations still exceeded 10 p.p.m. (isoflurane: 8 p.p.m.). It is concluded that urgent decontamination by a 20-min flush warrants the safe re-use of previously 'contaminated' conductive rubber and latex as well as polysulfone tubings in critical situations, e.g. in malignant hyperthermia patients if disposable tubing is not immediately available.(ABSTRACT TRUNCATED AT 250 WORDS)