Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialThoracic epidural analgesia compared with patient controlled intravenous morphine after upper abdominal surgery.
Twenty-one ASA I or II patients undergoing upper abdominal surgery were studied for 24 hours after operation. They were entered into a prospective, randomised study of patient-controlled intravenous morphine compared with continuous thoracic epidural fentanyl combined with 0.2% bupivacaine. ⋯ There was a reduced incidence of emetic symptoms in the epidural group (P < 0.05) but the incidence of other minor side effects did not differ significantly. Thoracic epidural fentanyl/bupivacaine results in significantly better analgesia than patient-controlled intravenous morphine.
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Acta Anaesthesiol Scand · Nov 1994
Randomized Controlled Trial Clinical TrialThe agreement between adductor pollicis mechanomyogram and first dorsal interosseous electromyogram. A pharmacodynamic study of rocuronium and vecuronium.
The agreement between evoked adductor pollicis mechanomyogram and first dorsal interosseous evoked electromyogram (EMG) was evaluated during a pharmacodynamic study of rocuronium and vecuronium. In the first place the effective doses of rocuronium producing 50% and 90% block (ED50 and ED90, respectively) were established in 32 neurolept anaesthetized patients from the adductor pollicis mechanomyogram and the first dorsal interosseous EMG area and amplitude. Secondly, limits of agreement between the two methods were evaluated from the mean difference between methods +/- 2 s.d. in 20 patients during onset of block following 2 x ED90 of rocuronium and vecuronium, and during recovery from the last supplementary dose of 1/2 x ED90. ⋯ Agreement between the amplitude and the area of the EMG were better than between the mechanomyogram and the EMG. Evaluation of the time courses of action showed that rocuronium had a faster onset of action than vecuronium (1.8 min compared to 2.8 min) while duration of action and reversal were similar. In conclusion, the first dorsal interosseous EMG amplitude and area can be used to assess rocuronium and vecuronium block.
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Acta Anaesthesiol Scand · Nov 1994
Randomized Controlled Trial Clinical TrialPlatelet activation in major surgical stress: influence of combined epidural and general anaesthesia.
Platelets are activated in surgery releasing vasoactive substances such as serotonin and thromboxane. Platelets become temporarily hypoaggregable during surgery followed by a postoperative hyperaggregability. Local anaesthetics are known to inhibit platelet function but earlier reports are conflicting. ⋯ Postoperatively both groups showed significant hyperaggregability. The release products were not significantly influenced by regional anaesthesia. In conclusion epidural as combined with general anaesthesia affects platelet responses to major abdominal surgery only to a minor extent, although it may attenuate the haemodynamic response.
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Acta Anaesthesiol Scand · Nov 1994
Randomized Controlled Trial Clinical TrialAnaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), Part I: Isoflurane produces dose-dependent coronary vasodilation.
The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double-blinded protocol. After induction with fentanyl (3 micrograms.kg-1) and thiopentone (2-4 mg.kg-1) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n = 20), halothane (n = 19) or fentanyl (15-20 micrograms.kg-1) (n = 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. ⋯ Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose-dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities. The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24%, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P = 0.008 and P = 0.001, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.
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Acta Anaesthesiol Scand · Nov 1994
Randomized Controlled Trial Clinical TrialThoracic epidural analgesia in aortocoronary bypass surgery. II: Effects on the endocrine metabolic response.
Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may-in part-be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS). ⋯ A significant increase in adrenalin, noradrenalin and SVR was found in the HF group whereas this increase was blocked in both epidural groups. An increase in glucose and cortisol was noticed in all groups, but the increase was delayed in the epidural groups. Our results suggest that a more effective blockade of the stress response during ACBS is obtained when TEA is added to general anaesthesia than with high dose fentanyl anaesthesia alone.