Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Sep 2014
Controlled Clinical TrialAssessment of deep tissue hyperalgesia in the groin - a method comparison of electrical vs. pressure stimulation.
Deep pain complaints are more frequent than cutaneous in post-surgical patients, and a prevalent finding in quantitative sensory testing studies. However, the preferred assessment method - pressure algometry - is indirect and tissue unspecific, hindering advances in treatment and preventive strategies. Thus, there is a need for development of methods with direct stimulation of suspected hyperalgesic tissues to identify the peripheral origin of nociceptive input. ⋯ The presented tissue-specific direct deep tissue electrical stimulation technique has equal or superior reliability compared with the indirect tissue-unspecific stimulation by pressure algometry. This method may facilitate advances in mechanism based preventive and treatment strategies in acute and chronic post-surgical pain states.
-
Acta Anaesthesiol Scand · Sep 2014
Randomized Controlled TrialDexmedetomidine does not reduce emergence agitation in adults following orthognathic surgery.
Patients undergoing orthognathic surgery are at high risk of developing emergence agitation. We hypothesised that a single-dose of dexmedetomidine would reduce emergence agitation in adults with nasotracheal intubation after orthognathic surgery. ⋯ The addition of a single dose of dexmedetomidine (1 μg/kg) to low-dose remifentanil infusion did not attenuate emergence agitation in intubated patients after orthognathic surgery compared with low-dose remifentanil infusion alone. However, single-dose dexmedetomidine suppressed coughing, haemodynamic changes, and pain during emergence and recovery phases, without respiratory depression. Delayed awakening might be associated with this treatment.
-
Acta Anaesthesiol Scand · Sep 2014
Case ReportsUse of neuromuscular monitoring to detect prolonged effect of succinylcholine or mivacurium: three case reports.
Mutations in the butyrylcholinesterase gene can lead to a prolonged effect of the neuromuscular blocking agents, succinylcholine and mivacurium. If the anaesthesiologist is not aware of this condition, it may result in insufficient respiration after tracheal extubation. However, this can be avoided with the use of objective neuromuscular monitoring if used adequately. ⋯ Both patients had insufficient respiration. They were therefore re-sedated, transferred to the intensive care unit and the tracheas were extubated after full recovery from neuromuscular blockade. We recommend the use of monitoring every time these agents are used, even with short-acting drugs like succinylcholine and mivacurium.
-
Acta Anaesthesiol Scand · Sep 2014
Randomized Controlled Trial Comparative StudyThe effects of propofol vs. sevoflurane on post-operative pain and need of opioid.
Maintaining anesthesia with either sevoflurane or propofol for laparoscopic gynaecology surgery has no differential effect on post-operative pain.
pearl -
Acta Anaesthesiol Scand · Sep 2014
Review Comparative StudyRecovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery.
The objective of this review was to systematically assess the effect of thoracic epidural analgesia (TEA) vs. systemic analgesia (SA) on the recovery of gastrointestinal (GI) function in patients following GI surgery. We performed a comprehensive literature search to identify randomized controlled trials of adult patients undergoing GI surgery, comparing the effect of two postoperative analgesia regimens. Patients postoperatively receiving local anesthesia-based TEA with or without opioids were compared to patients receiving opioid-based SA. ⋯ The occurrence of postoperative hypotension was relatively higher in the TEA group, risk ratio: 7.9, 95% CIs: 2.4 to 26.5, P = 0.001; other side effects (such as pruritus and vomiting) were similar in the two groups. There is evidence that TEA (compared to SA) improves the recovery of GI function after GI procedures without any increased risk of GI complications. To further confirm these effects, larger, better quality randomized controlled trials with standard outcome measurements are needed.