Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1996
ReviewAwareness in anaesthesia: incidence, consequences and prevention.
Awareness during anaesthesia is a state of consciousness that is revealed by explicit or implicit memory of intraoperative events. Although large clinical surveys indicate an incidence of explicit awareness of < 0.3% during anaesthesia for general surgery, this adverse effect should be a great concern, because patients may be permanently disabled by the experience of being awake during surgery. ⋯ The anaesthetic depth should be assessed by observation of movement responses, and consequently a minimum of muscle relaxants used. Because the anaesthetic depth can be controlled by determination of endtidal drug concentration, volatile inhaled anaesthesia may be associated with a lower frequency of awareness than other anaesthetic regimens.
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Acta Anaesthesiol Scand · Oct 1996
Randomized Controlled Trial Clinical TrialCardiovascular effects of desflurane and isoflurane in patients with coronary artery disease.
Anaesthesia in patients with ischaemic heart disease may cause adverse haemodynamic reactions. This investigation compares the cardiovascular effects of equipotent concentrations of desflurane and isoflurane in 30 patients (ASA III) with coronary artery disease before surgical stimulation. ⋯ The results of this study demonstrate that in patients with coronary artery disease the haemodynamic effects of equipotent concentrations of desflurane and isoflurane are similar except for a significant increase in PAP and PCWP caused by desflurane. Therefore, desflurane should be administered with great caution if it is used as an alternative anaesthetic in patients with ischaemic heart disease.
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Acta Anaesthesiol Scand · Oct 1996
Cerebral autoregulation is impaired in patients resuscitated after cardiac arrest.
Cerebral autoregulation is important to maintain a constant perfusion in the face of changes in blood pressure. It is reported to be impaired in pathologic states, including hypertension, cerebral infarction, and head injury. However, it is not clear whether cerebral autoregulation is impaired in resuscitated patients after cardiac arrest. ⋯ Assuming that the cerebral metabolic rate of oxygen does not change during the interventions in MAP, the changes of CBFI and SjvO2 seen after the decrease or increase in MAP indicate that cerebral autoregulation was impaired in these resuscitated patients. The degree of the impairment of cerebral autoregulation may be secondary to the degree of brain injury caused by the cerebral ischemia accompanying cardiac arrest.
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Acta Anaesthesiol Scand · Oct 1996
Epidural and intrathecal opioids for postoperative pain management in Europe--a 17-nation questionnaire study of selected hospitals. Euro Pain Study Group on Acute Pain.
A questionnaire study conducted with the help of selected contact persons in 17 countries in Europe attempted to create a picture of the practice of acute pain management with the use of spinal opioid analgesia (SOA). ⋯ This questionnaire study showed that SOA was used in about 7% of 836,000 in-patients undergoing surgery at the 105 selected hospitals. Epidural opioids were used eight times more often than intrathecal opioids. Morphine was the commonest opioid for SOA. The duration of monitoring differed greatly between hospitals and countries; the need for official guidelines is emphasized.
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Acta Anaesthesiol Scand · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialEpidural vs. intravenous infusion of alfentanil in the management of postoperative pain following laparotomies.
This study was designed to compare the efficacy of epidural vs. intravenous administration of alfentanil for treatment of postoperative pain. ⋯ Compared to intravenous infusion of alfentanil epidural infusion resulting in the same plasma concentrations is not more effective in relieving postoperative pain. In view of this observation we were not able to demonstrate a spinal mechanism of alfentanil.