Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 1993
Clinical Trial Controlled Clinical TrialMetabolic consequences of different perioperative fluid therapies in the neonatal period.
Carbohydrate and fat metabolism during and after anaesthesia and surgery was studied in 14 neonates with major congenital non-cardiac anomalies. They were either given a glucose solution until surgery or starved for at least 4 h before surgery. Ringer-acetate alone or Ringer-acetate plus 10% glucose was used for the intraoperative fluid therapy. ⋯ The triglyceride levels were equal in both groups. In two neonates given glucose before surgery and Ringer-acetate during surgery increased levels of 3-hydroxybutyrate were found, particularly in one patient who became hypoglycaemic. In conclusion, starved neonates without intraoperative glucose supply mobilized fat and maintained blood glucose concentrations.
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Acta Anaesthesiol Scand · Feb 1993
Randomized Controlled Trial Clinical TrialIntrathecal morphine for the relief of post-hysterectomy pain--a double-blind, dose-response study.
Eighty patients undergoing total abdominal hysterectomy under general anaesthesia were randomly divided into four groups to study the dose-response relationship of intrathecal morphine (0, 0.1, 0.3 and 0.5 mg) for postoperative pain relief. Pain scores, as assessed by using the visual analogue scale, revealed that intrathecal morphine provided long-lasting pain relief, was most effective after 0.3 mg and significantly reduced the need for supplementary analgesics (P < 0.05). ⋯ There was no incidence of respiratory depression in any of the patients in this study. The incidence of side effects was least following 0.3 mg intrathecal morphine, which we consider to be the optimum dose.
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Acta Anaesthesiol Scand · Feb 1993
Randomized Controlled Trial Comparative Study Clinical TrialInterpleural bupivacaine for analgesia during chest drainage treatment for pneumothorax. A randomized double-blind study.
The ability of interpleural analgesia to reduce the pain caused by an indwelling chest drain was evaluated in 22 patients treated for spontaneous pneumothorax. Intermittent 8-hourly bolus injections of 20 ml bupivacaine 0.5% with epinephrine were compared with placebo in a randomized double-blind fashion. Visual analogue pain scale (VAS) scores were registered after the 1st, 2nd, 4th, 7th and 10th injections. ⋯ Parenteral morphine consumption was not significantly lower in the bupivacaine group. Arterial blood gases were unaffected by the treatment in both groups. It is concluded that interpleural analgesia using bupivacaine given as bolus injections at 8-h intervals significantly reduces the pain caused by a chest drain within 5 min of injection, but the duration of pain relief is less than 4 h.
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Acta Anaesthesiol Scand · Feb 1993
Contribution of rib cage and abdominal movement to ventilation for successful weaning from mechanical ventilation.
In order to test the hypothesis whether the breathing pattern is helpful in predicting weaning outcome in patients being weaned from mechanical ventilation, 38 patients who underwent operation for esophageal cancer were evaluated at weaning from mechanical ventilation (19 unsuccessful weanings, group U, and 19 successful weanings in age-matched patients, group S). Since all patients initially fulfilled our weaning criteria, ventilatory parameters such as tidal volume, respiratory frequency, minute ventilation, and arterial blood gas analysis showed no significant differences between the groups. The breathing pattern was registered quantitatively by means of respiratory inductive plethysmography at 3 cmH2O (0.3 kPa) of CPAP prior to weaning. ⋯ Indeed, 84% of the patients in group S showed %RC less than 50%, compared to only 16% of the patients in group U (P < 0.05). The results suggest that the breathing pattern is one important factor in predicting the outcome of weaning in patients after thoraco-abdominal surgery. Diaphragmatic fatigue is suspected to be the mechanism for the increase in the RC component in patients with unsuccessful weaning outcome.
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Acta Anaesthesiol Scand · Feb 1993
Laboratory methods for detecting disseminated intravascular coagulation (DIC): new aspects.
The objective was to diagnose a hypercoagulative state or "pre-DIC" with new laboratory tests. APACHE II score was used as a measure of primary illness. Ventilator time was used as a reflexion of secondary complications. ⋯ Prothrombin complex, APTT, platelet count and AT III were pathologic to the same extent in both groups. The patients who developed most secondary complications, resulting in longer ventilator treatment (Group I), were also hypercoagulative. Soluble fibrin, in particular, seems to be valuable in the diagnosis of "pre-DIC" and possibly of predictive value for organ system complications.