Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2001
Randomized Controlled Trial Clinical TrialEffect of expiratory resistance on gas-exchange and breathing pattern in chronic obstructive pulmonary disease (COPD) patients being weaned from the ventilator.
The majority of patients with severe chronic obstructive pulmonary disease (COPD) have flow limitation, which has deleterious side effects. If these patients are mechanically ventilated, this often results in difficult weaning. Spontaneously breathing COPD patients experience a beneficial effect of pursed lip breathing. We investigated whether in intubated COPD patients application of an external resistance could produce the same beneficial effects on breathing pattern and gas-exchange as pursed lip breathing. ⋯ In intubated COPD patients being weaned from the ventilator, application of an external resistance did not have the same beneficial effects as pursed lip breathing.
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Acta Anaesthesiol Scand · Oct 2001
ReviewOpioids in cancer and chronic non-cancer pain therapy-indications and controversies.
Indications for strong opioids for cancer-related pain as well as for chronic non-cancer pain are that non-opioid drugs, and other less risky therapies, fail and that the pain is opioid-sensitive. The WHO analgesic ladder principle continues to serve as an excellent educational tool in the efforts by WHO in collaboration with the World Federation of Societies of Anaesthesiologists (WFSA) and The International Association for the Study of Pain (IASP) to increase knowledge of pharmacological pain therapy and increase availability of essential opioid analgesics world-wide. Opioids differ in pharmacodynamics and pharmacokinetics, and patients have different pharmacogenetics and pain mechanisms. ⋯ Controversies continue concerning diagnosis and handling of opioid-insensitive pain in cancer and chronic non-cancer pain, opioid-induced neurotoxicities, risks of tolerance, addiction, pseudo-addiction, and methods for improving effectiveness and decreasing adverse effects of long-term opioid therapy, treating breakthrough pain with immediate release oral and transmucosal opioids. Consensus guidelines have recently been developed in the Nordic countries concerning the ethical practice of palliative sedation when opioids and other pain-relieving therapies fail in patients soon to die. Guidelines for long-term treatment with strong opioids of chronic non-cancer-related pain are also being developed in the Nordic countries, where very diverging traditions for the usage of such therapy still exist.
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In a multidisciplinary approach to the management of chronic pain, neurosurgical methods are an indispensable part of the therapeutic armamentarium. With the exception of percutaneous interventions for trigeminal neuralgia and facet joint syndromes, most ablative pain surgery procedures (neurotomy, rhizotomy, sympathectomy, etc.) have been replaced by neuromodulatory approaches such as electrical stimulation of the central nervous system (CNS). However, cordotomy is still a valuable operation for certain forms of cancer related pains (Pancoast's syndrome, breakthrough pain) which are relatively resistant to pharmacotherapy. ⋯ SCS has also been found to be useful for pain in peripheral vascular disorders and angina pectoris. In the latter condition the overall results are favorable in about 80% of patients with a significant reduction of the frequency and severity of angina attacks and the need for nitrates. Stimulation of the motor cortex is a novel and promising treatment of central, post-stroke pain and painful trigeminal neuropathy.
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Acta Anaesthesiol Scand · Oct 2001
Randomized Controlled Trial Clinical TrialIntraoperative epidural blockade prevents the increase in protein breakdown after abdominal surgery.
The aim of this study was to investigate the effect of epidural blockade with bupivacaine, restricted to the intraoperative period, on protein catabolism after major abdominal surgery. ⋯ Intraoperative epidural blockade inhibits the increase in protein breakdown after abdominal surgery.
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Acta Anaesthesiol Scand · Oct 2001
Airway management behaviour, experience and knowledge among Danish anaesthesiologists--room for improvement.
Problems with managing the airways in relation to anaesthesia causes severe morbidity and mortality. A large proportion of these adverse respiratory events is preventable. Still patients continue to die from airway disasters related to anaesthesia, also in Scandinavia. The goal of this study is to identify which efforts are likely to improve this situation. ⋯ There is room for improvement regarding airway management skills among Danish anaesthesiologists. It is likely that airway management can be improved by: A) Better knowledge of an appropriate plan, algorithm, for airway management. B) Awake intubation used more often. C) More experience in fibreoptic intubation. D) All anaesthesiologists accepting that previous difficult intubation is an indicator of future difficulties. E) All anaesthesiologists knowing, and practising on manikins, how to oxygenate via the cricothyroid membrane. F) Always having a laryngeal mask airway immediately available when inducing anaesthesia.