Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 1993
Comparative StudyVolume-controlled inverse ratio ventilation: effect on dynamic hyperinflation and auto-PEEP.
The effects of inverse ratio ventilation (IRV) and PEEP on dynamic hyperinflation and auto-PEEP were studied in sedated, paralysed patients with adult respiratory distress syndrome (ARDS) (n = 9) and in 10 postoperative patients after coronary artery by-pass (CABG). During volume-controlled mechanical ventilation with constant tidal volume (V(T) 12 ml.kg-1) and respiratory rate (12.min-1), two consecutive experiments were carried out: (1) with constant I:E ratio PEEP was increased in steps of 2 cmH2O (0.2 kPa) from 0 to 12 cmH2O (0 to 1.2 kPa) and (2) with no PEEP I:E ratio was changed stepwise from 1:4 to 4:1. Flow, V(T), peak airway pressure (Pmax) and static end-expiratory pressure (PEEPtot) were registered. ⋯ The changes in the end-expiratory lung volume (EELV) were measured with respiratory inductive plethysmograph. We found that: (1) increasing PEEP and IRV caused a similar increase in EELV and PEEPtot in ARDS, but in CABG the increase in EELV was greater with PEEP; (2) at the same PEEPtot the increase in EELV was similar with PEEP and IRV in both groups; and (3) the reduction in Pmax was marginal during IRV. We conclude that the effect of reduced expiratory time on end-expiratory lung volume and pressure during volume controlled IRV is similar to the use of PEEP.
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Acta Anaesthesiol Scand · Apr 1993
Randomized Controlled Trial Clinical TrialBeclomethasone prevents postoperative sore throat.
The effects of a dose of beclomethasone inhaler (50 micrograms) or lidocaine 10% spray on postoperative sore throat were studied in 120 patients undergoing tracheal intubation for elective surgical procedures. Fifty-four patients (90%) in the beclomethasone group scored no postoperative sore throat compared with 27 (45%) in the lidocaine group (P < 0.001). Beclomethasone inhaler seems to be highly effective in the prevention of postoperative sore throat and is therefore to be recommended before tracheal intubation for general anaesthesia.
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Acta Anaesthesiol Scand · Apr 1993
Randomized Controlled Trial Clinical TrialEffect of dihydroergotamine on leg blood flow during combined epidural and general anaesthesia and postoperative deep vein thrombosis after cholecystectomy.
The effects of dihydroergotamine (DHE) on the circulation of the leg during combined epidural and general anaesthesia were studied to determine if DHE would enhance leg blood flow and prevent postoperative deep vein thrombosis in a double-blind trial of 40 elderly female patients subjected to cholecystectomy. Central and big toe temperature, arterial blood pressure, heart rate, calf volume and arterial inflow of the leg by electrical impedance plethysmography and the venous outflow by Doppler method were measured. DHE 0.5 mg subcutaneously reduced the volume of the leg, i.e. increased the electrical impedance, probably due to venous vasoconstriction. ⋯ Intraoperative characteristics in patients with postoperative DVT were tachycardia (P < 0.001), enhanced need for etilefrine (P < 0.01) and a more rapid increase in big toe temperature (P < 0.05) after induction of epidural analgesia, compared with patients without DVT. Femoral vein flow velocity remained at the preinduction level, whereas pulsatile arterial inflow slightly increased. Together with a low basal impendance of the leg, the changes were indicative of a more intense vasodilatation, probably leading to stagnant flow and development of postoperative deep vein thrombosis.
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Acta Anaesthesiol Scand · Apr 1993
Randomized Controlled Trial Clinical TrialIsoflurane inhibits muscle fasciculations caused by succinylcholine in children.
The incidence and intensity of muscle fasciculations as well as the occurrence of cardiac arrhythmias following succinylcholine were evaluated in 36 premedicated children (1.0-5.7 years) after intravenous induction with thiopentone or after inhalation induction with isoflurane (3.75 vol-% in 70% nitrous oxide in oxygen). The study was randomized. ⋯ No cardiac arrhythmias were noted in either group. In conclusion, isoflurane in nitrous oxide inhibits succinylcholine-induced muscle fasciculations in children.
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Acta Anaesthesiol Scand · Apr 1993
Mivacurium-induced neuromuscular blockade in patients with atypical plasma cholinesterase.
The duration of action of mivacurium was evaluated during a modified neurolept anaesthesia in 17 patients heterozygous for the usual and the atypical plasma cholinesterase (pChe) gene (E1uE1a) and in five patients homozygous for the atypical gene (E1aE1a). The response to train-of-four nerve stimulation was recorded using a Myograph 2000. Five heterozygous patients were given a small dose of mivacurium 0.03 mg kg bw-1 intravenously (Group 1). ⋯ In all five patients the neuromuscular block was successfully antagonized with neostigmine preceded by atropine. In conclusion, mivacurium-induced neuromuscular blockade was moderately prolonged in patients heterozygous for the usual and the atypical gene for plasma cholinesterase. Patients homozygous for the atypical plasma cholinesterase gene appear to be markedly sensitive to mivacurium.