Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Nov 1999
Changes in stroke volume cause change in cardiac output in neonates and infants when mean airway pressure is altered.
Based on early studies in the lamb, and in spite of more recent studies in humans, it has been the received opinion that neonates and infants can not change their stroke volume significantly, but are mainly dependent on changes in heart rate, to change cardiac output. To further evaluate the relationship between cardiac output and stroke volume during mechanical ventilation of neonates and infants, we have studied the effects on cardiac output and stroke volume by two different ways of changing mean airway pressure. ⋯ We conclude that neonates and infants are able to regulate cardiac output by changing the stroke volume to a greater extent than presumed, at least when cardiac output is influenced by changes in the mean airway pressure.
-
Acta Anaesthesiol Scand · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialIntraarticular, epidural, and intravenous analgesia after total knee arthroplasty.
After total knee arthroplasty, patients regularly suffer from severe pain. It is unclear whether epidural or systemic pain therapy is superior in terms of postoperative pain relief, patients' comfort and side effects. A new therapeutic approach, intraarticular opioids, has been suggested with the detection of opioid receptors in inflamed tissue. This method has proven suitable for clinical use in small operations (e.g. knee arthroscopy). In this study, we compared epidural analgesia and intraarticular application of morphine plus "on-demand" intravenous analgesia to "on-demand" intravenous analgesia alone. ⋯ Epidural and intravenous analgesia after total knee arthroplasty are equivalent methods of pain relief. In major orthopaedic procedures, application of intraarticular morphine does not reduce analgesic requirements.
-
Acta Anaesthesiol Scand · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialLateral infraclavicular plexus block vs. axillary block for hand and forearm surgery.
In the last few years infraclavicular plexus block has become a method of increasing interest. However, this block has been associated with high complication incidences and without advantage in the quality of blockade over the axillary approach. We prospectively studied 40 patients (ASA I-III) undergoing surgery of the forearm and hand, and investigated the performance of the lateral infraclavicular plexus block against an axillary paravascular block to evaluate the success rate as well as the extent and quality of blockade. ⋯ Based on the safe landmark and feasibility of this procedure and the additional spectrum of nerve block achieved, the application of lateral infraclavicular technique has to be reconsidered in clinical practice.
-
Acta Anaesthesiol Scand · Nov 1999
Randomized Controlled Trial Clinical TrialThe effects of two rewarming strategies on heat balance and metabolism after coronary artery bypass surgery with moderate hypothermia.
Postoperative hypothermia is common in cardiac surgery with hypothermic cardiopulmonary bypass (CPB). This trial was designed to evaluate whether rewarming over the normal bladder temperature (over 37 degrees C) at the end of hypothermic CPB combined with passive heating methods after CPB might result in a better heat balance, lower energy expenditure (EE) and decrease of disturbances in oxygen balance compared to only rewarming the patients to a bladder temperature of 35-37 degrees C. ⋯ With rewarming the patients at the end of CPB to a bladder temperature of over 37 degrees C combined with passive heating methods after CPB, it was possible to decrease EE and VO2 compared to the control group (rewarmed to bladder temperature of 35-37 degrees C) after coronary artery bypass surgery with moderate hypothermia.
-
Acta Anaesthesiol Scand · Nov 1999
Randomized Controlled Trial Clinical TrialMild hypothermia does not increase blood loss during total hip arthroplasty.
The effects of mild hypothermia on blood loss are little known. ⋯ Forced air warming did not decrease the blood loss. Methods for determination of blood loss yielded widely differing results.