Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 1996
No additional metal particle formation using the needle-through-needle combined epidural/spinal technique.
Combined epidural/spinal analgesia utilizing a needle-through-needle technique has become very popular in anesthesia. However, findings of concave deformities at the orifice of Tuohy needles after spinal needle passage have raised concerns that metal fragments might be deposited within the epidural space. This study was proposed to investigate whether the needle-through-needle technique does produce metallic flecks. ⋯ Metallic particles are not produced by the needle-through-needle technique. However, metal particles are an apparent contaminant of all epidural needles and are probably routinely introduced into patients when the needle is placed.
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Acta Anaesthesiol Scand · Feb 1996
The efficacy of intrathecal injection of sufentanil using a microspinal catheter for labor analgesia.
Intrathecal sufentanil can provide labor analgesia. We investigated the efficacy of multiple injections and the maternal and neonatal effects of intrathecal sufentanil during labor. Seventeen healthy women in active labor received multiple injections of intrathecal sufentanil of 5 micrograms each through microspinal catheters. ⋯ Results from our study suggest that multiple small doses of sufentanil administered intrathecally provided satisfactory analgesia for parturients with short duration of labor since acute tolerance developed with multiple injections. High incidence of mild or moderate pruritus was observed during the study. Close attention should be given to hemodynamically unstable patients when this technique is applied.
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Acta Anaesthesiol Scand · Feb 1996
Randomized Controlled Trial Clinical TrialBalanced analgesia improves recovery and outcome after outpatient tubal ligation.
Outpatient surgery benefits patients only if postoperative sequelae are effectively treated. After laparoscopic tubal ligation (TL) intense pain and consequent postoperative nausea and vomiting (PONV) has been a problem delaying recovery and resulting in hospital admission. Ninety patients were randomised to this double-blind study, the aim being to evaluate the effect of balanced analgesia on postoperative pain and recovery after sterilization. ⋯ Postoperative pain and analgesic requirements, incidence of PONV and need for antiemetic medication were all significantly lower in the balanced analgesia group. Home readiness was consistently achieved 70-90 min sooner in the balanced analgesia group compared to the other groups (P < 0.01 between the balanced analgesia and the placebo group), and the patients were able to return to normal activity sooner (cumulatively 93% of the patients in the balanced analgesia group vs. 60% in the other two groups (P < 0.01 between the balanced analgesia and the other groups) had returned to normal activity on the 2nd postoperative day). It is concluded that in patients undergoing laparoscopic TL the combination of analgesic regimens with different mechanisms of action offer a simple and efficient way of postoperative pain relief, as well as an improvement of quality (i.e. less PONV) and speed of recovery.
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Acta Anaesthesiol Scand · Feb 1996
Midlatency auditory evoked potentials during anaesthesia with increasing endexpiratory concentrations of desflurane.
Under general anaesthesia with the volatile anaesthetics halothane, enflurane and isoflurane, midlatency auditory evoked potentials (MLAEP) are suppressed dose-dependently. Therefore, MLAEP have been used to measure depth of anaesthesia and to indicate intraoperative awareness. Desflurane is a new volatile anaesthetic and its effect on MLAEP have not been studied previously. ⋯ Based on these observations, endexpiratory concentrations of > or = 4.5 vol % desflurane should suppress awareness phenomena such as auditory perceptions during anaesthesia.
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Acta Anaesthesiol Scand · Feb 1996
Neutrophil and macrophage activation and anaphylatoxin formation in orthotopic liver transplantation without the use of veno-venous bypass.
Activation of neutrophils and activation of complement may be an aetiologic factor behind circulatory insufficiency in association with reperfusion of the grafted liver. ⋯ Activation of neutrophils and macrophages and of the complement cascade with the formation of biologically active substances may be one explanation for the circulatory instability often seen in patients undergoing orthotopic liver transplantation.