Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 1993
Postoperative pain relief, from the patients' and the nurses' point of view.
In this prospective, consecutive study, 191 patients were interviewed before and after surgery (orthopaedic, gynaecological, abdominal and urological operations) about their attitude to and the quality of received pain relief, respectively. In addition, nurses working in the surgical units involved in the study were asked to answer a questionnaire covering attitudes to postoperative pain and pain treatment. Of the patients, 47% were in pain at the time of the postsurgical interview, 10% had not any analgesic prescribed at all and 15% had received less than prescribed. In 36% of the cases there was a discrepancy between the amount of analgesic prescribed by the surgeon and the amount prescribed by the anaesthetist. In 80% of the patients the pain outlasted the first postoperative day, but only 64% would always tell the staff if they had pain. Seventeen per cent of the patients had never been asked about their postoperative pain status. Preoperative pain had a significant correlation to postoperative pain. Although the results are not impressive, they do constitute some improvement compared to previously published studies. Fifty-one nurses (71% of the total nursing staff) answered the questionnaire. Of these, 63% were sometimes in doubt about the physicians' prescriptions, 55% would occasionally refuse to give analgesics for various reasons, and 37% were not satisfied with the routines of pain control in their ward. ⋯ Knowledge of pain treatment and communication between surgeons, anaesthesiologists, nurses and patients must be improved to make postsurgical pain relief adequate.
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Acta Anaesthesiol Scand · May 1993
Comparative StudyEndotracheal tube versus face mask with and without continuous positive airway pressure (CPAP).
Various ways of delivering continuous positive airway pressure (CPAP) have been extensively studied, with little attention, however, being paid to the effects of an intubation tube compared with breathing through a face mask, with or without CPAP. Pulmonary and cardiovascular variables were measured while 12 patients recovering from coronary artery bypass grafting were spontaneously breathing at ambient airway pressure, then at 7.4 mmHg (1 kPa) CPAP, and again at ambient pressure just before extubation. The same stages were repeated immediately after extubation, with patients breathing through a tight-fitting face mask. ⋯ Cardiac output remained unchanged in all the breathing modes. After coronary artery bypass grafting, spontaneous breathing with a face mask resulted in better Pao2 than breathing through an endotracheal tube, both with and without 7.4 mmHg (1 kPa) CPAP. This study indicates that unnecessary delay in extubation should be avoided.
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Acta Anaesthesiol Scand · May 1993
Is there a cholinergic and an adrenergic phase of the oculocardiac reflex during strabismus surgery?
We investigated the counterregulatory effect of the oculocardiac reflex (OCR) in 25 infants and children during strabismus surgery under three experimental conditions. In group 1, a series of measurements were recorded when the OCR was elicited by traction. The beat-to-beat heart rate reduction ranged from -26 to -64 beats/min (median: -46 beats/min). ⋯ The bradycardia and the counterregulation may be referred to as cholinergic and adrenergic phrases of the OCR. Atropine eliminates the cholinergic phase. Our study indicates that there may be receptors and afferent fibres for both phases, which can be blocked by local anaesthetics.
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Acta Anaesthesiol Scand · May 1993
Complications related to thoracic epidural analgesia: a prospective study in 1071 surgical patients.
In a prospective study, the complications of 1071 patients scheduled for thoracic epidural catheterization for postoperative analgesia (TEA) were studied. All catheters were inserted preoperatively between segment Th 2/3 and Th 11/12 under local anesthesia. Balanced anesthesia with endotracheal intubation and TEA were combined. ⋯ Although 116 patients (10.83%) showed one abnormal clotting parameter but no clinical signs of hemorrhage, there was no complication related to this group. No persisting neurological sequelae caused by the thoracic epidural catheters were found. In conclusion, continuous TEA with buprenorphine for postoperative pain relief after major abdominal surgery is a safe method without too high a risk of catheter-related or drug-induced complications, even on a normal surgical ward and when one clotting parameter is abnormal.
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Colloid osmotic pressure (COP) of some of the most frequently used plasma replacement fluids was measured with a colloid osmometer. COP of 4% human albumin solutions was only half that of normal human serum (13.6 +/- 0.6 vs. 27.5 +/- 2.7 mmHg (1.8 +/- 0.1 vs. 3.7 +/- 0.4 kPa)) (mean +/- s.d.), whereas COP of 20% human albumin solutions was eight times higher (196.0 +/- 12.3 mmHg (26.1 +/- 1.6 kPa)). Enhancing the protein concentration from 4% to 20% in the human albumin solutions increased COP 14-fold, reflecting the exponential relationship between protein concentration and COP of a solution. ⋯ Dextran 70 (6%) had a COP more than twice, and Ringer-Dextran 60 (3%) about 75% of that of normal human serum. Dextran 40 (10%) and gelatin (3.5%, Haemaccel) leaked markedly through the membrane of the colloid osmometer, making acceptable measurements impossible. Seven different hydroxyethyl starch (HES) solutions were measured, and the COP varied between half and 3 times that of normal human serum, depending on molecular weight and concentration of the HES.