Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2002
Case ReportsIntrathecal fentanyl/meperidine combined with low-dose epidural bupivacaine for Cesarean section in a patient with advanced Krukenberg tumors.
This case report demonstrates the anesthetic management of a 41-year-old primiparous parturient with massive ascites due to advanced Krukenberg tumors, undergoing Cesarean section. We chose a combined intrathecal-epidural technique, using intrathecal hypobaric fentanyl and hyperbaric meperidine, and a low dose of epidural bupivacaine in order to avoid hemodynamic instability in this critically ill patient. ⋯ Opioid-related complications such as nausea-vomiting, pruritus, drowsiness, and respiratory depression were not observed in this patient. Therefore, intrathecal opioids combined with a low dose of epidural local anesthetics for Cesarean section is suitable for critically ill patients with malignant abdominal tumors, such as a Krukenberg tumor, complicated by massive ascites.
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Acta Anaesthesiol Scand · Nov 2002
Randomized Controlled Trial Comparative Study Clinical TrialProspective, randomized cost analysis of anesthesia with remifentanil combined with propofol, desflurane or sevoflurane for otorhinolaryngeal surgery.
In the era of cost containment, cost analysis should demonstrate the cost-effectiveness of new anesthetic drugs. ⋯ This study demonstrates that REM-based anesthetic techniques are more expensive than a conventional technique using alfentanil, isoflurane and N2O. This is the result of higher costs of anesthetic and nonanesthetic drugs and of disposables. The wastage of intravenous drugs contributes considerably to these costs.
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Acta Anaesthesiol Scand · Nov 2002
Randomized Controlled Trial Clinical TrialTranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study.
Extensive blood loss in total knee replacement (TKR) surgery is well known and is associated with a high transfusion rate of allogenic blood. Tranexamic acid (TXA) has been shown to reduce blood loss by 50% in this patient group, but only in cases with a perioperative loss of 1400-1800 ml. This study was performed to see if TXA offers any advantages in knee replacement surgery with blood loss at 800 ml. ⋯ We conclude that TXA significantly reduces blood loss after total knee replacement surgery.
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Acta Anaesthesiol Scand · Nov 2002
Randomized Controlled Trial Clinical TrialCerebrospinal fluid concentrations of atracurium, laudanosine and vecuronium following clinical subarachnoid hemorrhage.
Neuromuscular blocking agents may exert central nervous system effects when they reach the brain. This study assessed the concentrations and the time course of passage of vecuronium, atracurium, and its metabolite laudanosine in the cerebrospinal fluid (CSF) of patients undergoing intracranial aneurysm clipping. ⋯ Significant concentrations of atracurium and laudanosine but not of vecuronium were detected in the CSF of patients during and immediately after intracranial aneurysm surgery.