Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Clinical TrialEffects of 2-, 4- and 12-hour fasting intervals on preoperative gastric fluid pH and volume, and plasma glucose and lipid homeostasis in children.
We evaluated 105 randomly-selected unpremedicated children aged 1-14 years to determine the effects of a 2-, 4- and 12-h preoperative fasting interval on the preoperative gastric fluid pH and volume, and plasma glucose and lipid homeostasis. Each child undergoing elective surgery ingested a large volume (approximately 10 ml/kg b.w.) of apple juice and then fasted for 2, 4 or 12 h before the estimated induction of anaesthesia. After induction of anaesthesia, gastric fluid was aspirated through a large-bore, multiorifice orogastric tube. ⋯ Both 4 and 12 h nil per os (NPO) caused an increase in lipolysis, which was presumably a compensatory mechanism to maintain normoglycaemia. The plasma NEFA and total ketone bodies concentrations were therefore significantly higher in these two fasting intervals than in 2 h NPO. These data suggest that a 2-h NPO, after a large volume of ingested apple juice, may offer additional benefits by preventing an increase in lipolysis during the fasting interval without either increasing the volume of gastric fluid or decreasing the gastric pH.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Nov 1993
Randomized Controlled Trial Clinical TrialEpidural analgesia with 4 mg of morphine following caesarean section: effect of injected volume.
The efficacy and side effects of epidural bolus injection of 4 mg of morphine in a volume of 2 ml, 10 ml, or 20 ml (groups I, II and III) for postoperative analgesia after caesarean section (60 patients) were evaluated. All patients had epidural anaesthesia established up to T4 level with 0.5% bupivacaine 18-20 ml, supplemented with 2% lidocaine with adrenaline, when necessary. Morphine 4 mg in either of the three volumes was injected through the epidural catheter in random order after delivery of the baby. ⋯ S.). After removal of the urinary catheter 7/20 patient in group III required carbachol for urinary retention compared to 3/20 and 4/20 patients in groups I and II (N. S.).(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Oct 1993
Randomized Controlled Trial Clinical TrialPatient-controlled analgesia (PCA) leads to more postoperative pain relief, but also to more fatigue and less vigour.
This investigation evaluated patient-controlled analgesia (PCA) for subjective well-being and mood in the postoperative period in comparison with the intramuscular (im) administration of morphine given on demand. Patients scheduled for elective upper abdominal surgery were assigned at random to either PCA (n = 17) or im morphine (n = 14). ⋯ The PCA patients suffered from more fatigue and showed less vigour than the im group. Neither preoperative trait anxiety nor locus of control was associated with postoperative pain in either of the groups.
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Acta Anaesthesiol Scand · Oct 1993
Randomized Controlled Trial Clinical TrialHydroxyethyl starch as a prime for cardiopulmonary bypass: effects of two different solutions on haemostasis.
Hydroxyethyl starch (HES) is efficacious as a volume expander in cardiac surgical patients, but it may impair the haemostatic mechanisms. However, this latter effect may be less conspicuous with low molecular weight (LMW) solutions than with high molecular weight (HMW) solutions. Therefore, LMW- and HMW-HES solutions were evaluated as priming solutions for cardiopulmonary bypass (CPB) with respect to their effect on haemostasis. ⋯ Plasma levels of von Willebrand factor antigen and factor VIII procoagulant activity were significantly more depressed after CPB in both HES-groups as compared with the crystalloid prime group. In addition, APTT was more prolonged and the maximal amplitude of thromboelastographic tracing was more decreased in the HES-groups. It is concluded that it may be advisable to avoid HES solutions in the CPB prime, especially in patients with an increased risk for bleeding after cardiac operations.
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Acta Anaesthesiol Scand · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialA comparison between vecuronium and atracurium in myasthenia gravis.
We evaluated the effect of vecuronium bromide and atracurium besylate on the train-of-four response in the management of muscle relaxation in 20 patients with myasthenia gravis (MG) who were undergoing thymectomy. We confirmed the safe use of these two non-depolarizing muscle relaxants in MG patients. ⋯ The recovery time for vecuronium patients was shorter than that for atracurium patients (22 +/- 18 vs 38 +/- 18 min), but the time until onset of neuromuscular blockade was longer with vecuronium (246 +/- 105 vs 107 +/- 103 s). During spontaneous recovery from neuromuscular relaxation, at T1/C of 25% and 100%, the train-of-four fade with vecuronium was significantly greater than that with atracurium (0.04 +/- 0.02, 0.16 +/- 0.03 vs 0.17 +/- 0.01, 0.83 +/- 0.03), suggesting that vecuronium had a greater prejunctional effect than did atracurium.