Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 1992
Randomized Controlled Trial Clinical TrialEffect of a non-steroidal anti-inflammatory drug, diclofenac, on haemostasis in patients undergoing total hip replacement.
Haemostasis was studied in patients receiving diclofenac for postoperative pain relief. Intravenous diclofenac 75 mg over 60 min, followed first by an infusion of 5 mg/h for 15 h and then by 50 mg every 8 h orally was administered to 20 patients undergoing total hip replacement. Eighteen patients receiving a placebo infusion and dextropropoxyfen per os served as controls. ⋯ The mean diclofenac concentrations were 28 +/- 5 nmol/ml (+/- s.d.) after 15 min and 36 +/- 12 nmol/ml after the second infusion. The bleeding time in the arthroscopy patients receiving one or two bolus infusions of 75 mg diclofenac remained at the control level. It is concluded that diclofenac given as an intravenous infusion of 75 mg in 60 min, then 5 mg/h for 15 h, followed by 50 mg every 8 h orally, is a safe as dextropropoxyfen for pain relief in patients undergoing major orthopaedic surgery as far as coagulation data are concerned.
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Acta Anaesthesiol Scand · Jul 1992
Randomized Controlled Trial Clinical TrialInfluence of intrathecal morphine and naloxone intervention on postoperative ventilatory regulation in elderly patients.
Thirty elderly patients undergoing major hip surgery under spinal analgesia were randomly allocated in a double-blind manner into three groups. The aim was to evaluate the influence of intrathecal morphine and postoperative naloxone infusion on the regulation of ventilation. The Bupivacaine Group received spinal analgesia with 20 mg bupivacaine intrathecally. ⋯ Postoperative administration of opioids or sedatives after intrathecal morphine as well as postoperative blood loss associated with a fall in blood pressure appeared to increase the risk of developing respiratory depression. Naloxone infusion seemed to reduce the risk of developing respiratory depression. Furthermore, one third of the elderly had a poor response to hypoxaemia before surgery.
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The object of this study was to investigate the influence of haematocrit on the accuracy of pulse oximetry. Seven Swedish land race rabbits were studied. The oxygen saturation of haemoglobin was decreased step-wise using increasing fractions of nitrogen to the inspiratory gas. ⋯ No correlation between SpO2 and SaO2 was found when the sensor was attached directly over the artery during normal haematocrit levels. After haemodilution a better correlation was however obtained. These results indicate that the accuracy of pulse oximetry is dependent on the haematocrit level.
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Acta Anaesthesiol Scand · Jul 1992
Interscalene plexus block for arthroscopy of the humero-scapular joint.
Interscalene plexus block was performed in nine patients subjected to shoulder arthroscopy. The operating conditions, including muscle relaxation, were fully adequate in all patients (after additional local anaesthesia of the skin in four patients). ⋯ Interscalene block might be a suitable alternative to general anaesthesia for shoulder arthroscopy. However, additional local anaesthesia at the site where the arthroscope is to be inserted is frequently required.
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Acta Anaesthesiol Scand · Jul 1992
Epinephrine as an adjuvant to amino-amide local anesthetics does not prolong their duration of action in infraorbital nerve block in the rat.
The effects of epinephrine as an adjuvant to local anesthetics were studied in the rat infraorbital nerve block (IONB) model, using solutions of 0.5% prilocaine, 0.5% mepivacaine, 0.125% bupivacaine or 0.125% ropivacaine in 50 mmol/l tris-hydroxymethylaminomethane (THAM) tested both without and with epinephrine (EPI) added at 2, 4, 8 or 16 micrograms/ml. Solutions of THAM and EPI in normal saline did not induce IONB. THAM-buffered solutions of bupivacaine induced IONB of longer duration than bicarbonate-buffered solutions. ⋯ Low concentrations of EPI in solutions of bupivacaine and ropivacaine significantly reduced their duration of action by up to 22% and 57%, respectively. It is concluded that the duration of action of local anesthetics in buffered solutions is only moderately affected by the inclusion of EPI, the effects differing only slightly from one to another. The efficacy of EPI as an adjuvant would seem to be governed by factors affecting the local disposition of the main drugs, such as non-specific binding, buffering of solutions and tissue pH.