Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialPropofol anaesthesia versus paracervical blockade with alfentanil and midazolam sedation for outpatient abortion.
Propofol anaesthesia was compared with paracervical blockade in a prospective, randomized study of 59 abortion patients. All the patients received alfentanil 0.01 mg/kg i.v. at the start of anaesthesia and were randomized into two groups. Group R (regional, 31 patients): midazolam 0.1 mg/kg i.v. and paracervical blockade with 2 x 10 ml of mepivacaine 20 mg/ml + adrenaline 0.005 mg/ml. ⋯ Except for a better p-deletion score 30 min after the procedure in Group G, there was no difference in recovery function between the groups. Of the patients in Group G, 67% experienced postoperative pain compared with 23% in Group R. Maximum serum mepivacaine concentration (Group R) was reached at 15-30 min, range 1.5-5 micrograms/ml.
-
Acta Anaesthesiol Scand · Jan 1992
Randomized Controlled Trial Clinical TrialAttenuating the hypertensive response to laryngoscopy and endotracheal intubation using awake fibreoptic intubation.
Blood pressure and pulse rate measurements were recorded in 35 patients undergoing endotracheal intubation during general anaesthesia (Group A), and 35 patients who had an awake fibreoptic intubation under local anaesthesia (Group B). The mean arterial pressure in Group A rose by a mean of 35 mmHg immediately after intubation, compared with a mean fall of 9 mmHg in Group B. The mean pulse rate in Group A rose by 24 beats per minute (b.p.m.) immediately after intubation, compared with a rise of 3 b.p.m. in Group B. ⋯ There was a statistically higher mean score in relation to nose discomfort in Group B (P less than 0.002). Awake fibreoptic intubation successfully reduces the pressor response to endotracheal intubation in normotensive adults. It is suitable for use in those patients who are at risk from the pressor response.
-
Acta Anaesthesiol Scand · Jan 1992
Comparative StudyDoes the anesthetic method influence the postoperative breathing pattern and gas exchange in hip surgery? A comparison between general and spinal anesthesia.
We studied the effects of elective hip surgery, performed under either spinal (SA, n = 10) or general anesthesia (GA, n = 10), on breathing pattern and gas exchange. Measurements were made with respiratory inductive plethysmograph and indirect calorimetry in two positions before and after surgery. The method of anesthesia had no effect on the severity of postoperative hypoxemia. ⋯ The contribution of rib cage to tidal volume increased postoperatively in the supine position (P less than 0.001; SA from 32.6% +/- 10.3 to 46.3% +/- 7.5, GA from 36.5 +/- 16.4 to 48.5% +/- 15.4). CO2 production, oxygen consumption and energy expenditure remained unchanged. The postoperative changes in breathing pattern are related to the operation, not to the type of anesthesia and do not explain the alterations in gas exchange.
-
Acta Anaesthesiol Scand · Jan 1992
Comparative StudyEffectiveness of pressure support ventilation for mechanical ventilatory support in patients with status asthmaticus.
We compared the effects of pressure support ventilation (PSV) with those of assist control ventilation (ACV) on breathing patterns and blood gas exchange in six patients with status asthmaticus. Both PSV and ACV delivered adequate minute ventilation (PSV: 7.5 +/- 1.4 l/min/m2, ACV: 7.3 +/- 1.3 l/min/m2) to correct respiratory acidosis (pH = 7.33 +/- 0.12 during both PSV and ACV) and prevent hypoxia. ⋯ The oxygen cost of breathing estimated by oxygen consumption was equivalent in both modes. We conclude that PSV is effective in supplying tidal volumes adequate to improve hypercarbia at markedly lower airway pressures than ACV.
-
Two patients with acute severe asthma, who failed to respond to conventional therapy, were given intravenous ketamine in sub-anaesthetic doses with good results. A bolus dose of 0.75 mg/kg was followed by the same dose over 10 min with relief of bronchospasm in both cases. ⋯ Intravenous ketamine can be used to relieve acute intractable bronchospasm provided expert anaesthetic help is at hand. A review of the literature concerning its use in such situations is also presented.