Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 1994
Comparative StudyAssessment of sensory block in epidural anaesthesia by electric stimulation.
The onset of sensory block in lumbar epidural anesthesia was investigated in 26 patients, aged 18 to 84 years, employing the loss of discrimination to cold and pinprick, as well as by determining threshold electric stimulation (threshold intensities). A standard dose of 2% mepivacaine with adrenaline, 5 micrograms.ml-1, (0.1 ml per cm body height) was given and the patients' ability to discriminate stimuli within dermatomes T8, T10, T12, L2, L4 and S1 was investigated at five min intervals for 30 min after injection. From the results of the study it is concluded that i) The interval to peak analgesic efficacy of the anaesthetic solution used is < 30 min when assessments are based on the patients' ability to discriminate cold or pinprick but > 30 min when determinations of threshold intensities are employed. ii) Cold discrimination is lost earlier than discrimination to pinprick and at lower threshold intensities. iii) Threshold intensities describe the time course of onset of sensory block more precisely than results of testing by cold or pinprick. iv) The onset of sensory block was found to be positively correlated to the age of patients in the following respects: a) Threshold intensities during early onset in all investigated dermatomes except L2. b) Intensity of block in T8, T10, and S1 at the end of the study period. c) Time to loss of discrimination to cold and pinprick in T12, L2 and S1, and d) Threshold intensities at loss of discrimination to cold and pinprick. We propose that determinations of threshold intensities offer distinct advantages over conventional testing by cold and pinprick discrimination, especially when detailed analyses of the sensory blocking effects of local anaesthetic drugs are being investigated.
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialOesophageal intubation can be undetected by auscultation of the chest.
Prompt detection of oesophageal intubation is a primary concern in anaesthetic practice. This blind, randomised study evaluates three widely used tests of intubation. Forty patients had both their trachea and oesophagus intubated, each patient was studied twice. ⋯ P = 0.001 and P = 0.048, respectively. The tests were carried out after gastric distension with gas had occurred. We conclude that auscultation of epigastrium, right and left axilla, are recommended.
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialPrediction of outcome from intensive care after gastroenterologic emergency.
Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II-system. The models were constructed by using data from a random two-thirds of the study population and validated in the remaining independent one-third together with the original APACHE II-index. ⋯ These probabilities should be interpreted cautiously, taking into account the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialHigh-frequency jet ventilation vs continuous positive airway pressure for differential lung ventilation in patients undergoing resection of thoracoabdominal aortic aneurysm.
Twenty patients, scheduled for surgical resection of thoracoabdominal aortic aneurysm were divided into two groups according to the type of differential lung ventilation used during graft replacement of the descending thoracic aorta. In the high-frequency jet ventilation (HFJV) group of ten patients, HFJV was applied to the left lung once collapsed and retracted by the surgeon, the patient lying in the right lateral decubitus and being intubated by a Carlens' tube. In the continuous positive airway pressure (CPAP) group of ten patients, CPAP was applied to the left lung at the same mean airway pressure as HFJV (1 kPa). ⋯ Haemodynamic and respiratory measurements were made; 15 min after positioning the patients in the right lateral decubitus using two-lung ventilation; 15 min after collapse and retraction of the left lung using one-lung ventilation and 15 min after using differential lung ventilation with CPAP or HFJV. Left lung collapse with conventional one-lung ventilation induced a dramatic decrease in arterial oxygenation: PaO2/FIO2 ratio decreased from 43 +/- 6 kPa to 20 +/- 8 kPa, alveolo-arterial oxygen difference increased from 24 +/- 7 kPa to 72 +/- 11 kPa and pulmonary shunt increased from 17 +/- 2% to 37 +/- 3%. Whereas differential lung ventilation with CPAP did not improve any of the respiratory parameters measured, differential lung ventilation with HFJV, significantly increased PaO2/FIO2 ratio to 41 +/- 14 kPa.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialImmediate and prolonged effects of pre- versus postoperative epidural analgesia with bupivacaine and morphine on pain at rest and during mobilisation after total knee arthroplasty.
Thirty-two patients scheduled for total knee arthroplasty were randomized to receive an identical epidural blockade initiated 30 min before surgical incision (N = 16), or at closure of the surgical wound (N = 16). Before induction of general anaesthesia the epidural catheter was tested with bupivacaine 7.5 mg.ml-1, 2 ml. General anaesthesia was induced with thiopentone, pancuronium or atracurium, and fentanyl 0.1-0.3 mg, and maintained with N2O/O2 and enflurane. ⋯ Paracetamol 1000 mg every 8 h was administered from 48 h to 7 days postoperatively. No significant differences were observed in request for additional opioids, or in pain scores at rest or during mobilisation of the operated limb, during or after cessation of the epidural regimen. These results do not suggest timing of analgesia with a conventional, continuous epidural regimen to be of major clinical importance in patients undergoing total knee arthroplasty.