Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 1994
Randomized Controlled Trial Clinical Trial Retracted PublicationInfluence of volume replacement with different HES-solutions on microcirculatory blood flow in cardiac surgery.
A variety of hydroxyethyl starch HES preparations with different molecular weight average (Mw) and molar substitution (MS) is available for volume replacement during acute normovolemic haemodilution (ANH). Particularly with regard to microcirculation, the ideal solution for volume therapy has not been found. The influence of four different HES preparations on macro- and microcirculation was investigated in 40 patients scheduled for elective aorto-coronary bypass grafting and undergoing ANH (preoperative withdrawn blood: 10 ml.kg-1): 1) 6% HES with Mw of 450,000 dalton and MS of 0.7; 2) 6% HES with Mw of 200,000 dalton and MS of 0.5; 3) 6% HES with Mw of 200,000 dalton and MS of 0.62; 4) 6% HES with Mw of 40,000 dalton and MS of 0.5. ⋯ After ANH, skin capillary blood flow measured at the forehead decreased in all patients except in patients of group 2 (200/0.5: max. +18%). Group 3 (200/0.62) showed the highest decrease in forehead-LDF. During CPB, forehead-LDF decreased significantly in groups 3 (200/0.62) and 4 (40/0.5).(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · May 1994
Comparative StudyParavertebral vs epidural block in children. Effects on postoperative morphine requirement after renal surgery.
Continuous thoracic paravertebral blockade (PVB) has only recently been reported in pediatric patients. The aim of the present study was to compare retrospectively the postoperative analgesic efficacy of PVB vs conventional lumbar epidural blockade (EDA) in children. Thirty-five consecutive pediatric patients undergoing renal surgery, receiving either PVB (n = 15) or EDA (n = 20), were reviewed. ⋯ The need for supplemental morphine administration was significantly lower (P = 0.046) and the number of patients with no need for supplemental morphine administration postoperatively was significantly higher (P = 0.019) in patients treated with PVB vs EDA. The present study indicates that PVB may possess a potential for postoperative analgesia equal to or maybe even superior to conventional lumbar EDA in pediatric patients undergoing renal surgery. Further prospective studies investigating the analgesic efficacy of this novel technique are warranted.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialContinuous positive airway pressure by mask in patients after coronary surgery.
Thirty patients who underwent coronary artery bypass grafting were randomized to receive 30% oxygen by mask either with an ambient airway pressure or with 7.4 mmHg (1 kPa) continuous positive airway pressure (CPAP) for 8 h after extubation. Arterial blood oxygen tension (PaO2) decreased remarkably in the control group after extubation (from 19.2 +/- 5.3 kPa to 12.4 +/- 2.7 kPa) but less in the CPAP group (from 16.4 +/- 3.3 kPa to 14.0 +/- 2.1 kPa). ⋯ Atelectasis was more common in patients with internal thoracic artery grafting and/or pleural drainage. In conclusion, CPAP therapy was well tolerated, and minimized the decrease in PaO2 after extubation, but could not prevent the poor oxygenation or the late development of atelectatic areas on the second postoperative day.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialInterpleural or thoracic epidural analgesia for pain after thoracotomy. A double blind study.
The analgetic effect of bupivacaine given epidurally or interpleurally after thoracotomy was investigated in a randomized, double blind, placebo controlled study. 32 patients with both an epidural and an interpleural catheter, were randomized to receive either interpleural or epidural analgesia. The interpleural group was given bupivacaine 5 mg.ml-1 with 5 microgram epinephrine as a 30 ml interpleural bolus, followed by a continuous infusion starting at a rate of 7 ml per hour and epidurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. ⋯ Adequacy of pain relief was evaluated with the Prins-Henry pain scale. Morphine requirement was registered, there was no difference between the groups in pain scores or need for additional morphine.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialIntraarticular morphine for pain relief after knee arthroscopy performed under regional anaesthesia.
Eighty patients scheduled to undergo knee arthroscopy were studied in random and double blind fashion. Spinal anaesthesia with hyperbaric 0.5% bupivacaine was selected for 40 overnight-in-patients. At the end of arthroscopy, 1 mg morphine or saline was injected intraarticularly. ⋯ Duration of analgesia was slightly longer after morphine than in the control group (ns). There was no difference between the morphine patients and the control patients in the two studies regarding the incidence of side effects. We conclude that postoperative analgesia in patients undergoing knee arthroscopy under local anaesthesia, but not under bupivacaine spinal anaesthesia, can be improved with a single intraarticular injection of 1 mg morphine.