Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2002
Case ReportsNeurohistopathologic findings after a neurolytic celiac plexus block with alcohol in patients with pancreatic cancer pain.
Pancreatic cancer has a very poor prognosis resulting in the death of 98% of patients. Pain may be severe and difficult to treat. Management of pain includes chemotherapy, radiotherapy, pharmacologic treatment, and neurolytic celiac plexus block. ⋯ Post-mortem neurohistopathologic examination of the celiac plexus revealed an abnormal celiac architecture with a combination of abnormal neurons with vacuolization and normal looking neuronal structures (ganglionic structures and nerve fibers) embedded in fibrotic hyalinized tissue. Our results show that a neurolytic celiac plexus block with alcohol is capable of partially destroying the celiac plexus. These findings may explain the significant but short-lasting analgesic effect following neurolytic celiac plexus block with alcohol.
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Acta Anaesthesiol Scand · Aug 2002
Interpretation of radial pulse contour during fentanyl/nitrous oxide anesthesia and mechanical ventilation.
Peripheral arterial blood pressure is not a reliable substitute for proximal aortic pressure. Recognition of this phenomenon is important for correct appreciation of cardiac afterload. Our aim was to evaluate the utility of the radial pulse wave to better understand ventriculo-vascular coupling during anesthesia. ⋯ These elderly coronary patients had stiff vasculature (high aortic AI) and considerable pulse wave reflection, which was beneficially delayed by fentanyl. Changes in the radial pulse wave augmentation during mechanical ventilation were mainly a result of cyclic changes in the stroke volume, and were seldom associated with an increased systolic pressure gradient from the aorta to the radial artery.
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Acta Anaesthesiol Scand · Aug 2002
Epidural blood patch for management of postdural puncture headache in adolescents.
In some patients spinal puncture (SP) is followed by postdural puncture headache (PDPH). When the symptoms of PDPH are severe and are not relieved within a few days an epidural blood patch (EBP) might be performed. The aim of this survey was to review requests for EBPs and to evaluate the effectiveness of EBP in patients aged 13-18 years during a 6.5 year period ending in June 2001. ⋯ Epidural blood patch seems to be an effective and safe procedure in adolescents for treating severe and persistent PDPH.
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Acta Anaesthesiol Scand · Aug 2002
Randomized Controlled Trial Clinical TrialAuditory evoked potential monitoring with the AAITM-index during spinal surgery: decreased desflurane consumption.
The auditory evoked potential (AEP) is sensitive to the depth of anesthesia. The A-line monitor is a novel device that processes the amplitude and latency of the AEP during the mid-latency time window to provide a simple numerical index, the AAItrade mark-index. The hypothesis of the present study was that titration of anesthetic depth (desflurane) by means of the AAItrade mark-index could decrease the consumption of the main anesthetic and shorten emergence times. ⋯ Titrating depth of desflurane anesthesia using AAItrade mark-index guidance decreased main anesthetic consumption and improved emergence during spine surgery.
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Acta Anaesthesiol Scand · Aug 2002
Randomized Controlled Trial Clinical TrialNasal CPAP therapy: effects of different CPAP levels on pressure transmission into the trachea and pulmonary oxygen transfer.
Nasal continuous positive airway pressure (nCPAP) is considered useful for prophylaxis and treatment of respiratory complications following major thoracic surgery. It is unknown, however, which CPAP levels are required to avoid alveolar derecruitment and to consistently improve pulmonary oxygen transfer in patients following thoracotomy. We therefore studied the effects of different nCPAP levels on pressure transmission into the trachea as well as on pulmonary oxygen transfer. ⋯ Nasal CPAP is an effective non-invasive means of increasing tracheal and thus intrathoracic pressure without adverse hemodynamic effects. Only mask pressures of 9-10 cm H2O were sufficient to consistently improve pulmonary oxygen transfer in patients following thoracotomy.