Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of epidural methadone with epidural diamorphine for analgesia following caesarean section.
Analgesia provided by either 5 mg diamorphine, or 5 mg methadone administered by the epidural route during elective caesarean section was compared in 40 women. The median time to further analgesia in the methadone group was 395 min, and 720 min in the diamorphine group, P = 0.0003. Linear analogue scores to assess pain were measured 2-hourly for 12 h, then again at 24 h postoperatively. ⋯ Continuous pulse oximetry data were available for 12 h post-operatively in 15 patients receiving methadone, and in 17 patients receiving diamorphine. One or more episodes of significant desaturation (< 90% for 30 s), occurred in three patients receiving methadone, and in nine patients receiving diamorphine. Desaturation to 90-92% occurred in a further three patients given epidural diamorphine, and in one further patient given epidural methadone.
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Acta Anaesthesiol Scand · May 1993
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialCaudal buprenorphine for postoperative analgesia in children: a comparison with intramuscular buprenorphine.
This study was conducted on 44 children aged 1-10 years, who had undergone lower extremity orthopaedic surgery under general anaesthesia. Patients were divided into two groups: Group 1 (n = 23) received buprenorphine caudally and Group 2 (n = 21) received buprenorphine intramuscularly, at the completion of the surgery. The dose of buprenorphine used in both the groups was 4 micrograms.kg-1 body weight. ⋯ The duration of analgesia was significantly greater with caudal buprenorphine (median 20.20 h) than with intramuscular buprenorphine (median 5.20 h). Of the patients in the caudal group, 43% did not require any supplemental analgesia during the first 24 h, whereas all the patients in the intramuscular group required supplements within 10 h postoperatively. Caudal buprenorphine (4 micrograms.kg-1 body weight) provided 10.8 h to more than 24 h of analgesia in children, with fewer side effects.
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Acta Anaesthesiol Scand · May 1993
Postoperative pain relief, from the patients' and the nurses' point of view.
In this prospective, consecutive study, 191 patients were interviewed before and after surgery (orthopaedic, gynaecological, abdominal and urological operations) about their attitude to and the quality of received pain relief, respectively. In addition, nurses working in the surgical units involved in the study were asked to answer a questionnaire covering attitudes to postoperative pain and pain treatment. Of the patients, 47% were in pain at the time of the postsurgical interview, 10% had not any analgesic prescribed at all and 15% had received less than prescribed. In 36% of the cases there was a discrepancy between the amount of analgesic prescribed by the surgeon and the amount prescribed by the anaesthetist. In 80% of the patients the pain outlasted the first postoperative day, but only 64% would always tell the staff if they had pain. Seventeen per cent of the patients had never been asked about their postoperative pain status. Preoperative pain had a significant correlation to postoperative pain. Although the results are not impressive, they do constitute some improvement compared to previously published studies. Fifty-one nurses (71% of the total nursing staff) answered the questionnaire. Of these, 63% were sometimes in doubt about the physicians' prescriptions, 55% would occasionally refuse to give analgesics for various reasons, and 37% were not satisfied with the routines of pain control in their ward. ⋯ Knowledge of pain treatment and communication between surgeons, anaesthesiologists, nurses and patients must be improved to make postsurgical pain relief adequate.
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Acta Anaesthesiol Scand · May 1993
Comparative StudyEndotracheal tube versus face mask with and without continuous positive airway pressure (CPAP).
Various ways of delivering continuous positive airway pressure (CPAP) have been extensively studied, with little attention, however, being paid to the effects of an intubation tube compared with breathing through a face mask, with or without CPAP. Pulmonary and cardiovascular variables were measured while 12 patients recovering from coronary artery bypass grafting were spontaneously breathing at ambient airway pressure, then at 7.4 mmHg (1 kPa) CPAP, and again at ambient pressure just before extubation. The same stages were repeated immediately after extubation, with patients breathing through a tight-fitting face mask. ⋯ Cardiac output remained unchanged in all the breathing modes. After coronary artery bypass grafting, spontaneous breathing with a face mask resulted in better Pao2 than breathing through an endotracheal tube, both with and without 7.4 mmHg (1 kPa) CPAP. This study indicates that unnecessary delay in extubation should be avoided.
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Acta Anaesthesiol Scand · May 1993
Is there a cholinergic and an adrenergic phase of the oculocardiac reflex during strabismus surgery?
We investigated the counterregulatory effect of the oculocardiac reflex (OCR) in 25 infants and children during strabismus surgery under three experimental conditions. In group 1, a series of measurements were recorded when the OCR was elicited by traction. The beat-to-beat heart rate reduction ranged from -26 to -64 beats/min (median: -46 beats/min). ⋯ The bradycardia and the counterregulation may be referred to as cholinergic and adrenergic phrases of the OCR. Atropine eliminates the cholinergic phase. Our study indicates that there may be receptors and afferent fibres for both phases, which can be blocked by local anaesthetics.