Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Sep 1996
ReviewThromboprophylaxis, coagulation disorders, and regional anaesthesia.
The surgery and trauma-induced modulation of the coagulation system includes a considerable risk of perioperative thromboembolic complications unless effective thromboprophylactic treatment is given. In the present survey the patient at risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is characterized and the documented efficacy of different currently used thromboprophylactic regimens is summarized. Systemic thromboprophylactic treatment may include a risk of an increased bleeding tendency which may lead to haemorrhagic complications. ⋯ Pregnancy is associated with changes in the haemostatic system, which in the preeclamptic or eclamptic patient may be rather pronounced and constitute a clinical problem since regional anaesthetic techniques are often preferred for obstetric anaesthesia/analgesia. The specific problems to be considered prior to the choice of regional anaesthesia/analgesia for a parturient with a suspected coagulation disorder are therefore commented on in more detail. Finally, recommendations are given for safe spinal and epidural analgesic and anaesthetic routines in patients with potential haemostatic disturbances due to thromboprophylactic treatment with anticoagulants or bleeding disorders.
-
Abstention from food and drink prior to anaesthesia remains a cornerstone in safe practice. Despite the lack of scientific support, previous guidelines, similar for fluids and solids, have for more than three decades more often than not recommended "nil by mouth" ("nothing-per-os"; "NPO" in the US) after midnight or a fixed duration of time. ⋯ Since there may be a discrepancy between conclusions based on scientific studies and the current routine practice-this presentation is intended to survey the current recommendations in different countries and how they relate to publications on the subject. Opinions are mainly derived from officers of associations linked to The World Federation for Anaesthesiologists (WFSA) and from current literature.
-
Anaesthesia induction and deep anaesthesia may be accompanied by a considerable haemodynamic depression, especially in patients suffering from cardiovascular diseases. A decrease in cardiac index (CI) leads to a concomitant decrease in oxygen transport (DO2I). We examined whether these changes in haemodynamic performance and oxygenation can cause an oxygen debt and anaerobic metabolism. ⋯ We conclude that in patients suffering from a substantial cardiovascular disease systemic oxygenation is not impaired by considerable haemodynamic changes induced by general anaesthesia. This fact can be explained by the parallel decrease in oxygen demand, expressed by the decrease in VO2I.
-
Acta Anaesthesiol Scand · Sep 1996
Randomized Controlled Trial Clinical TrialThe combination of morphine with local anaesthetic in rhinoplasty--no evidence of a peripheral morphine effect.
The recognition of a peripheral opioid action has prompted a number of clinical reports demonstrating a prolonged analgesic effect of peripheral opiate. As most studies have used a model of intraarticular instillation of narcotic we examined direct morphine infiltration of the surgical site in a unique clinical model. ⋯ The results of this study indicate that the preoperative injection of intrawound morphine in combination with the local anesthetic both promotes bleeding and has an early pain-enhancing effect while providing no late analgesic benefit beyond that of IM morphine.
-
Acta Anaesthesiol Scand · Sep 1996
Randomized Controlled Trial Clinical TrialPreoperative ketorolac administration has no preemptive analgesic effect for minor orthopaedic surgery.
The utility of preoperative ketorolac administration to reduce the intensity and duration of postoperative pain was compared with placebo in a randomized double-blind design of 60 ASA 1-2 patients scheduled for minor orthopaedic surgery. No opioids nor local anaesthetic blocks were used during surgery. The patients received either 30 mg ketorolac IV before surgery followed by a placebo injection after surgery or the reverse. ⋯ No differences in pain intensity were observed between the two groups except for the initial 15-min postoperative assessments in the ketorolac group. The time to first rescue morphine administration and the total morphine consumption during the 6-h observation period were similar. It is concluded that the preoperative administration of ketorolac did not provide a significant preemptive analgesic benefit with regard to postoperative pain relief and opioid dose-sparing effect.