Acta anaesthesiologica Scandinavica
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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
Comparative StudyComparative histopathology of epidural hydrogel and silicone elastomer catheters following 30 and 180 days implant in the ewe.
New catheter materials, termed Hydrogels, have been developed recently that are stiff until exposed to hydration. The purpose of this study was to compare the 30 and 180 day histopathology of catheters composed of a common silicone elastomer versus a Hydrogel elastomer blend (HEB). Epidural catheters composed of either silicone or HEB were implanted in 19 yearling ewes for either 30 or 180 days. ⋯ The HEB catheter was easily inserted with standard epidural needles facilitated by the inherent stiffness of the catheter prior to hydration. HEB catheters remained patent throughout 30 days of saline injections per implanted ports. Silicone catheters demonstrated increased fibrosis relative to the HEB catheter material in the epidural space and in subcutaneous tissue.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialEffect of prior administration of succinylcholine on duration of action of vecuronium during enflurane anaesthesia.
The effects of succinylcholine, which was given to facilitate tracheal intubation on the duration of action of subsequently administered vecuronium bromide, were evaluated in 54 adult patients who underwent abdominal surgeries under enflurane anaesthesia. The electromyographic response to train-of-four ulnar nerve stimulation was measured. Twenty-seven patients received 1 mg.kg-1 of succinylcholine, followed by 0.15 mg.kg-1 of vecuronium when the electromyographic response recovered to 50% of control after succinylcholine-induced neuromuscular blockade. ⋯ The duration of blockade induced by the initial 0.15 mg.kg-1 of vecuronium was 56.5 +/- 12.8 (mean +/- s.d.) min for the group with succinylcholine, and 58.5 +/- 21.5 min for the control group. In both groups, the average duration of four consecutive supplemental doses of vecuronium was approximately 35 min. No significant differences between groups were found in the duration of neuromuscular blockade induced by initial and supplemental doses of vecuronium.
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Acta Anaesthesiol Scand · Apr 1994
Haemodynamic effects of pneumoperitoneum and the influence of posture during anaesthesia for laparoscopic surgery.
The laparoscopic operating technique is being applied increasingly to a variety of intra-abdominal operations. Intra-abdominal gas insufflation, i.e. pneumoperitoneum (PP), is then used to allow surgical access. The haemodynamic effects of PP in combination with different body positions have not been fully examined. ⋯ CI showed a certain dependency on filling pressures. It is concluded that PP causes signs of elevated preload and afterload. The combination of PP and a head-up tilt is associated only with signs of an elevated afterload.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialIntramuscular dexmedetomidine premedication--an alternative to midazolam-fentanyl-combination in elective hysterectomy?
Sedation, anxiolysis, intubation responses and fentanyl anaesthetic requirements were investigated in a double-blind, randomized study in twenty ASA I-II elective hysterectomy patients. Ten patients received dexmedetomidine 2.5 micrograms kg-1 i.m. 60 min before induction and saline placebo i.v. 2 min prior to induction (= DP group). Ten patients received midazolam 0.08 mg kg-1 i.m. 60 min and fentanyl 1.5 micrograms kg-1 i.v. (= MF group) 2 min before induction of anaesthesia with thiopentone 4 mg kg-1. ⋯ Fentanyl was required more often in MF group: median 3.5 (QD 1.5) vs. 2.5 (QD 0.5) times in DP group (P < 0.05), the total amount being 57% smaller in DP group: 0.03 (QD 0.01) vs. 0.07 (QD 0.02) micrograms kg-1 min-1 (P < 0.05). Postoperative course and analgesic requirements were similar in both groups. Dexmedetomidine premedication may offer an alternative to current anaesthesia practice in elective hysterectomy.