Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1995
Reperfusion after cardioplegic cardiac arrest--effects on intracoronary leucocyte elastase release and oxygen free radical mediated lipid peroxidation.
In experimental animal models reperfusion of ischaemic myocardium causes sequestration of leucocytes within the coronary circulation. Leucocytes contribute to postischaemic myocardial injury by releasing proteolytic enzymes and by generating oxygen free radicals. The aim of this study was to investigate whether leucocytes also contribute to myocardial injury following ischaemia and reperfusion associated with cardioplegic cardiac arrest. ⋯ Neither elastase nor malondialdehyde concentrations in coronary sinus blood differed significantly from arterial or central venous blood at any time point measured. Our data demonstrated increased elastase concentrations during cardiopulmonary bypass, but we did not find enhance intracoronary elastase release or myocardial during cardiopulmonary bypass, but we did not find enhanced intracoronary elastase release or myocardial lipid peroxidation. Our data suggest that patients are sufficiently protected from leucocyte mediated ischaemia reperfusion injury during uncomplicated coronary artery bypass grafting with cardioplegic arrest.
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Acta Anaesthesiol Scand · Oct 1995
Randomized Controlled Trial Clinical TrialPremedication with promethazine and transdermal scopolamine reduces the incidence of nausea and vomiting after intrathecal morphine.
Intrathecal morphine provides effective postoperative pain relief in major orthopaedic surgery. In use, however, is associated with unpleasant side effects like nausea and vomiting. The effect of different premedications on postoperative emetic sequelae induced by intrathecal morphine was studied in a prospective, double blind study. ⋯ PONV occurred in a majority of patients during the first 12 hours of the 24 hour study period and the need for additional analgesics thereafter. The incidence of itching (50-65%) and urinary catheterisation (55-70%) was similar in all groups. In conclusion, the combination of oral promethazine and transdermal scopolamine was most effective in reducing PONV symptoms and also reduced the need for postoperative pain treatment.
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Acta Anaesthesiol Scand · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe treatment of postanaesthetic shivering: a double blind comparison between alfentanil and pethidine.
It has been postulated that pethidine may mediate its effects on postanaesthetic shivering (PAS) via kappa-opioid receptors. However, clinical evidence indicates that alfentanil, a pure mu-agonist, may also have beneficial effects on PAS. In order to assess whether opioid effects on PAS are effected via kappa receptors, fifty-one patients were randomised to receive alfentanil 250 micrograms (n = 18), pethidine 25 mg (n = 18) or placebo (n = 15) on a double-blind basis for the treatment of established postanaesthesia shivering (PAS). ⋯ Following treatment, blood pressure fell and oxygen saturation increased in patients in the two treatment groups when compared with the control group (P < 0.05). There was a highly significant incidence of reshivering in the alfentanil treated group (P < 0.005). In conclusion, the high incidence of reshivering indicates that alfentanil is unlikely to supercede pethidine in the treatment of PAS, but its initial success rate implies that pethidine's anti-shivering effect is unlikely to be mediated via kappa-opioid receptors.
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Acta Anaesthesiol Scand · Oct 1995
Randomized Controlled Trial Clinical TrialPhenylephrine in treating maternal hypotension due to spinal anaesthesia for caesarean delivery: effects on neonatal catecholamine concentrations, acid base status and Apgar scores.
Maternal and neonatal catecholamine concentrations, following the use of either phenylephrine or ephedrine to treat a drop in maternal blood pressure after spinal anaesthesia for caesarean delivery, were compared. Patients were randomly assigned to one of two groups: Group 1 patients (n = 20) were treated with ephedrine given as 5 mg intravenous bolus injections; Group 2 patients (n = 20) were treated with phenylephrine given as 40 micrograms intravenous bolus injections, for decreases in maternal systolic blood pressure to maintain maternal systolic blood pressure above 100 mmHg. Maternal vein (MV), umbilical vein (UV), and umbilical artery (UA) blood samples were taken at the time of delivery. ⋯ No significant differences in maternal characteristics, acid base values, incidence of nausea and vomiting, and Apgar scores were observed between groups. Phenylephrine appears to be as safe and effective as ephedrine in treatment of drop in blood pressure in healthy non-labouring parturients undergoing caesarean delivery. The use of phenylephrine was also associated with significantly lower noradrenaline concentrations in both mother and neonate.
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Acta Anaesthesiol Scand · Oct 1995
Randomized Controlled Trial Clinical TrialThe duration of action of mivacurium is prolonged if preceded by atracurium or vecuronium.
We studied 45 patients (ASA I-II) during propofol-alfentanil-N2O-O2 anaesthesia to determine if recovery from neuromuscular block induced by mivacurium is influenced differently by prior injection of atracurium or vecuronium. Neuromuscular function was monitored by adductor pollicis EMG. Patients were randomized to receive two doses of either mivacurium (150 and 70 micrograms kg-1), atracurium (350 and 75 micrograms kg-1) or vecuronium (70 and 15 micrograms kg-1) followed by a final dose of mivacurium 70 micrograms kg-1. ⋯ Respective times were 100% longer if mivacurium had been preceded by atracurium (23.8 +/- 3.3 and 39.8 +/- 6.9) or vecuronium (22.6 +/- 3.5 and 44.1 +/- 7.9 min) (P = 0.0001). The 25-75% recovery times in the three groups were 4.9 +/- 1.0, 8.7 +/- 2.4 and 10.5 +/ 2.5 min, respectively (P = 0.0001). Our results indicate that there is no benefit in giving mivacurium at the end of surgery after peroperative use of atracurium or vecuronium.