Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 1993
Complications related to thoracic epidural analgesia: a prospective study in 1071 surgical patients.
In a prospective study, the complications of 1071 patients scheduled for thoracic epidural catheterization for postoperative analgesia (TEA) were studied. All catheters were inserted preoperatively between segment Th 2/3 and Th 11/12 under local anesthesia. Balanced anesthesia with endotracheal intubation and TEA were combined. ⋯ Although 116 patients (10.83%) showed one abnormal clotting parameter but no clinical signs of hemorrhage, there was no complication related to this group. No persisting neurological sequelae caused by the thoracic epidural catheters were found. In conclusion, continuous TEA with buprenorphine for postoperative pain relief after major abdominal surgery is a safe method without too high a risk of catheter-related or drug-induced complications, even on a normal surgical ward and when one clotting parameter is abnormal.
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Colloid osmotic pressure (COP) of some of the most frequently used plasma replacement fluids was measured with a colloid osmometer. COP of 4% human albumin solutions was only half that of normal human serum (13.6 +/- 0.6 vs. 27.5 +/- 2.7 mmHg (1.8 +/- 0.1 vs. 3.7 +/- 0.4 kPa)) (mean +/- s.d.), whereas COP of 20% human albumin solutions was eight times higher (196.0 +/- 12.3 mmHg (26.1 +/- 1.6 kPa)). Enhancing the protein concentration from 4% to 20% in the human albumin solutions increased COP 14-fold, reflecting the exponential relationship between protein concentration and COP of a solution. ⋯ Dextran 70 (6%) had a COP more than twice, and Ringer-Dextran 60 (3%) about 75% of that of normal human serum. Dextran 40 (10%) and gelatin (3.5%, Haemaccel) leaked markedly through the membrane of the colloid osmometer, making acceptable measurements impossible. Seven different hydroxyethyl starch (HES) solutions were measured, and the COP varied between half and 3 times that of normal human serum, depending on molecular weight and concentration of the HES.
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Acta Anaesthesiol Scand · May 1993
Comparative StudyVolume-controlled inverse ratio ventilation: effect on dynamic hyperinflation and auto-PEEP.
The effects of inverse ratio ventilation (IRV) and PEEP on dynamic hyperinflation and auto-PEEP were studied in sedated, paralysed patients with adult respiratory distress syndrome (ARDS) (n = 9) and in 10 postoperative patients after coronary artery by-pass (CABG). During volume-controlled mechanical ventilation with constant tidal volume (V(T) 12 ml.kg-1) and respiratory rate (12.min-1), two consecutive experiments were carried out: (1) with constant I:E ratio PEEP was increased in steps of 2 cmH2O (0.2 kPa) from 0 to 12 cmH2O (0 to 1.2 kPa) and (2) with no PEEP I:E ratio was changed stepwise from 1:4 to 4:1. Flow, V(T), peak airway pressure (Pmax) and static end-expiratory pressure (PEEPtot) were registered. ⋯ The changes in the end-expiratory lung volume (EELV) were measured with respiratory inductive plethysmograph. We found that: (1) increasing PEEP and IRV caused a similar increase in EELV and PEEPtot in ARDS, but in CABG the increase in EELV was greater with PEEP; (2) at the same PEEPtot the increase in EELV was similar with PEEP and IRV in both groups; and (3) the reduction in Pmax was marginal during IRV. We conclude that the effect of reduced expiratory time on end-expiratory lung volume and pressure during volume controlled IRV is similar to the use of PEEP.