Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1995
The influence of aging on skin temperature and hemodynamic changes during spinal anesthesia.
We investigated the influence of aging on the relationship between arterial pressure and skin temperature as a simple and indirect indicator of cutaneous blood flow. Sole and palm skin temperatures, sublingual temperature, heart rate, mean arterial blood pressure (MAP), and the anesthetic level as determined by cold discrimination, were measured before and during minor surgery under spinal anesthesia in patients under 65 years (young group) and above 65 years (elderly group). ⋯ The change in Tsole was less in elderly patients than that in young patients with the same decrease in MAP. These findings suggest that a decrease in peripheral resistance may not be the main cause of hypotension during spinal anesthesia in elderly patients.
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Acta Anaesthesiol Scand · Oct 1995
Transpulmonary disposition of prilocaine, mepivacaine, and bupivacaine in humans in the course of epidural anaesthesia.
The pulmonary first-pass kinetics of the amide-linked local anaesthetics prilocaine, mepivacaine and bupivacaine were studied in 33 patients after a single epidural injection. Drug concentrations were monitored before and after lung passage, i.e. in samples withdrawn simultaneously from mixed venous and arterial blood. In most cases, maximum plasma concentrations were observed 10 min after injection (range 2 to 30 min). ⋯ However, a transpulmonary concentration gradient could be observed only for a short time, i.e. maximum 15 min. Altogether, in the case of accidental fast absorption, e.g. inadvertent intravenous injection, arterial peak concentrations of these drugs will be attenuated by passage of the lung. However, the lung will not substantially lower the risk of toxicity by amide-linked local anaesthetics during normal conditions of regional anaesthesia where slow absorption occurs.
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Acta Anaesthesiol Scand · Oct 1995
Randomized Controlled Trial Clinical TrialReversal of atracurium-induced neuromuscular block in paediatric patients.
We studied the efficacy of neostigmine and edrophonium to reverse an atracurium-induced 90% neuromuscular block in 80 paediatric patients anaesthetized with thiopentone, fentanyl and nitrous oxide. The patients were divided into five age groups: 0-2 months, 3-11 months, 2-5 years, 6-10 years, and 11-15 years. At the end of surgery, the neuromuscular block was randomly antagonized with either neostigmine 50 micrograms kg-1 with atropine 20 micrograms kg-1 or with edrophonium 1 mg kg-1 with atropine 10 micrograms kg-1. ⋯ However, in each age group edrophonium had a faster onset of effect than neostigmine (P < 0.05) even though a greater TAO-ratio was finally reached with neostigmine. The effects of neostigmine were less variable and more predictable than those of edrophonium. Therefore, we recommend the use of neostigmine for routine paediatric practice.
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Acta Anaesthesiol Scand · Oct 1995
Editorial Comment ReviewNeurological complications of central nerve blocks.
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Acta Anaesthesiol Scand · Oct 1995
Comparative StudyPeripheral blood flow in the elderly during inhalational anaesthesia.
We investigated whether aging altered the peripheral vascular effects of inhaled anaesthetic agents. Forearm blood flow (FBF) was measured in 20 young (18-34 yrs) and 21 healthy elderly (60-79) patients receiving isoflurane or halothane with 66% nitrous oxide (N2O) in oxygen (O2). After etomidate 0.3 mg/kg and vecuronium 0.1 mg/kg, the trachea was intubated and controlled ventilation instituted with 66% N2O in O2. ⋯ We conclude that perfusion of forearm muscle and skin is maintained in the young but not in the elderly during anaesthesia with isoflurane/N2O. Perfusion of forearm muscle and skin decreases in both young and elderly patients during anaesthesia with halothane/N2O. The cardiovascular effects of isoflurane/N2O and halothane/N2O did not differ significantly in healthy elderly patients.