Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1998
Case ReportsIs development of hyperalgesia, allodynia and myoclonus related to morphine metabolism during long-term administration? Six case histories.
Recently, clinical reports have suggested a relationship between the occurrence of hyperalgesia, allodynia and/or myoclonus and treatment with high doses of morphine in humans. Although few clinical descriptions of these phenomena are available, experimental work supports the notion that high doses of morphine may play a pathogenetic role in the observed behavioural syndrome. ⋯ These results may indicate that elevated concentrations of M-3-G in plasma as well as the plasma and CSF M-3-G/M-6-G ratios may play a pathogenetic role in the development of hyperalgesia, allodynia and myoclonus.
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Acta Anaesthesiol Scand · Oct 1998
Epidural anaesthesia for caesarean delivery in triple and quadruple pregnancies.
Mechanical and/or hormonal factors may increase the spread of epidural anaesthesia in pregnancy, and hormonal changes are more pronounced in high-order pregnancies. However, no previous study has evaluated the dose requirements and haemodynamic effects of epidural anaesthesia for caesarean delivery in this latter situation. ⋯ We found surprisingly similar anaesthetic requirements for epidural anaesthesia in high-order and singleton pregnancies. Mechanical factors may have played an important role. Moreover, the need for ephedrine and fluids was less in high-order pregnancies. This could be related to more pronounced physiological changes or to different physician attitudes.
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Acta Anaesthesiol Scand · Oct 1998
Spreading pattern of epidurally administered contrast medium in rabbits.
The aim of this study was to examine the precise spreading pattern of epidurally administered contrast medium with small increments of injection volume for determining both the exact volume of the dose required and the site of epidural injection according to different target segments of the spinal cord in a rabbit epidural model. ⋯ In rabbits, it is recommended that at the lower thoracic or lumbar segments the tip of the epidural catheter should be located 1-3 segments below the target segment because of more rostral spread. In the case of mid-thoracic segments, however, placement at the target segment is recommended. In addition, a small titration of volume to achieve a particular range of epidural spread should be required.
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Acta Anaesthesiol Scand · Oct 1998
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the haemodynamic actions of desflurane/N2O and isoflurane/N2O anaesthesia in vascular surgical patients.
The purpose of this study was to compare heart rate and arterial blood pressure response to desflurane/N2O vs isoflurane/N2O anaesthesia in a randomized clinical trial performed in patients before vascular surgery. ⋯ We conclude that sympathetic hyperactivity previously reported during desflurane anaesthesia in healthy volunteers is not frequent in clinical practice in elderly vascular surgical patients under desflurane/N2O anaesthesia, since it occurs at an anaesthetic depth which cannot be reached in these patients because of the lowering arterial blood pressure effects of desflurane, which are similar to those of isoflurane.
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Acta Anaesthesiol Scand · Oct 1998
Randomized Controlled Trial Clinical TrialHydroxyethyl starch impairs in vitro coagulation.
Artificial colloids affect haemostasis. Particularly hydroxyethyl starch (HES) solutions may have detrimental effects on haemostatic mechanisms. ⋯ We conclude that HES at 20 and 50 vol.% concentrations has an adverse effect on in vitro measures of coagulation. A 50% dilution with high molecular weight HES seems to impair coagulation more than low molecular weight HES. Ringer's acetate and albumin caused a hypercoagulable state at a concentration of 20 vol.%, but the higher concentration decreased coagulability.