Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 1993
Complications and late sequelae following nasotracheal intubation.
A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to 5 days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in 76 (20%) and 110 patients (29%), respectively. ⋯ Former ulcerations of the nose were associated with a tendency to nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.
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Acta Anaesthesiol Scand · Jul 1993
Fluidity state of lymphocyte plasma membrane in malignant hyperthermia susceptible pigs and humans.
Recent studies suggest that abnormalities occur at the lipid level in malignant hyperthermia susceptible humans and pigs. To test this hypothesis, we first investigated the physical state of plasma membranes of lymphocytes isolated from normal and malignant hyperthermia susceptible swine. ⋯ We then attempted to apply the same methodology to lymphocytes prepared from human patients previously diagnosed by the halothane and caffeine contracture test. In that case, there was no clear relationship between malignant hyperthermia susceptibility and the fluidity state of lymphocyte plasma membranes.
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Acta Anaesthesiol Scand · Jul 1993
Case ReportsEpidural anesthesia in a patient with myasthenia gravis.
We present a patient with myasthenia gravis who was safely managed by epidural anesthesia during and after thymectomy. An epidural catheter was inserted via the C7-T1 intervertebral space and 2% lidocaine was used during the surgery. The level of analgesia as determined by pinprick extending from C5 to T6. ⋯ Ventilatory responses to CO2 and hypoxia were both depressed following epidural injection of morphine. However, depression of ventilatory responses was not demonstrated following continuous epidural infusion of a mixture of morphine and bupivacaine. This case report suggests that epidural anesthesia is useful as a primary anesthetic and for postoperative pain control in patients with myasthenia gravis.
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Acta Anaesthesiol Scand · May 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of epidural methadone with epidural diamorphine for analgesia following caesarean section.
Analgesia provided by either 5 mg diamorphine, or 5 mg methadone administered by the epidural route during elective caesarean section was compared in 40 women. The median time to further analgesia in the methadone group was 395 min, and 720 min in the diamorphine group, P = 0.0003. Linear analogue scores to assess pain were measured 2-hourly for 12 h, then again at 24 h postoperatively. ⋯ Continuous pulse oximetry data were available for 12 h post-operatively in 15 patients receiving methadone, and in 17 patients receiving diamorphine. One or more episodes of significant desaturation (< 90% for 30 s), occurred in three patients receiving methadone, and in nine patients receiving diamorphine. Desaturation to 90-92% occurred in a further three patients given epidural diamorphine, and in one further patient given epidural methadone.
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Acta Anaesthesiol Scand · May 1993
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialCaudal buprenorphine for postoperative analgesia in children: a comparison with intramuscular buprenorphine.
This study was conducted on 44 children aged 1-10 years, who had undergone lower extremity orthopaedic surgery under general anaesthesia. Patients were divided into two groups: Group 1 (n = 23) received buprenorphine caudally and Group 2 (n = 21) received buprenorphine intramuscularly, at the completion of the surgery. The dose of buprenorphine used in both the groups was 4 micrograms.kg-1 body weight. ⋯ The duration of analgesia was significantly greater with caudal buprenorphine (median 20.20 h) than with intramuscular buprenorphine (median 5.20 h). Of the patients in the caudal group, 43% did not require any supplemental analgesia during the first 24 h, whereas all the patients in the intramuscular group required supplements within 10 h postoperatively. Caudal buprenorphine (4 micrograms.kg-1 body weight) provided 10.8 h to more than 24 h of analgesia in children, with fewer side effects.