Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1993
Randomized Controlled Trial Clinical TrialAnalgesic action of metoclopramide in prosthetic hip surgery.
Prosthetic hip surgery was performed under subarachnoidal anaesthesia with bupivacaine 16-20 mg and morphine 0.2 mg. Preoperatively, metoclopramide 1 mg.kg-1 was given i.v., followed by an infusion of 1.5 mg.kg-1 over 9 h (n = 17). Control patients received corresponding volumes of solvent (n = 23. ⋯ The pain-free period was longer (P < 0.05) in the metoclopramide group. Arterial PCO2-levels were increased, reaching a maximum within 6 h of infusion, with no significant difference between the groups. The study suggests an analgesic action of metoclopramide.
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Acta Anaesthesiol Scand · Jan 1993
Comparative StudyIntra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia.
In situ saphenous vein arterial bypass flow was studied in 16 patients with respect to level of epidural anaesthesia. Arterial pressure and electromagnetic flow were used to evaluate arterial tone by intra-arterial (i.a.) papaverine. Eight patients had a low epidural block (< or = Th. 10) and eight patients were operated during high epidural anaesthesia (> Th. 10). ⋯ Increase in arterial flow after i.a. papaverine was not significantly different in patients operated in low epidural and general anaesthesia (n = 8). In eight patients with insulin-dependent diabetes mellitus who had low epidural anaesthesia, the increase in flow after i.a. papaverine was not significantly different to that noted during high epidural anaesthesia. The results indicate that the level of analgesia influences graft flow after i.a. papaverine, probably reflecting differences in the effect of epidural anaesthesia on sympathetic tone to the leg.
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Acta Anaesthesiol Scand · Jan 1993
Case ReportsProlonged total extracorporeal lung assistance without systemic heparinization.
A 16-year-old female developed severe ARDS in her single remaining lung following pneumonectomy for blunt trauma. Total extracorporeal lung assist (ECLA) for 40 days using a covalently heparin-coated circuit proved lifesaving. Systemic heparinization was not applied, as the heparinized surface by itself prevented clotting of the extracorporeal circuit. ⋯ After 40 days, lung recovery allowed discontinuation of ECLA. Five days later the patient suffered serious lung collapse and was operated for a bronchopleural fistula. The patient was extubated 4 weeks after terminating ECLA and discharged in good condition 5 weeks later.
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Acta Anaesthesiol Scand · Jan 1993
Randomized Controlled Trial Clinical TrialBlood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine.
Thirty-one patients scheduled for elective cholecystectomy performed through a mini-laparotomy, were randomized to received either combined thoracic epidural anaesthesia/light general anaesthesia and postoperative balanced analgesia with continuous epidural bupivacaine 10 mg.h-1 and morphine 0.2 mg.h-1 for 38 h after surgery plus systemic ibuprofen 600 mg x 8 h-1 (N = 15) or general anaesthesia and postoperative analgesia with systemic morphine and ibuprofen 600 mg x 8 h-1 (N = 16). During postoperative epidural infusion sensory blockade to pinprick was Th4 to L1, and analgesia at rest and during mobilisation was superior compared to systemic morphine and NSAID. ⋯ There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group at 24 h) or in number of episodes of dizziness, nausea or vomiting during rest or mobilisation. These results do not support the common belief that low-dose thoracic epidural bupivacaine/morphine may prevent ambulation due to sympathetic blockade or to impaired cardiovascular adaptation to the upright position.
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Acta Anaesthesiol Scand · Jan 1993
Randomized Controlled Trial Clinical TrialPreoxygenation techniques: the value of nitrous oxide.
Changes in arterial oxygen saturation during induction of anaesthesia and intubation were studied using the pulse oximeter. Seventy-five young ASA I patients undergoing elective uncomplicated surgery were divided equally into three groups. The patients were preoxygenated with 100% oxygen, 50% oxygen: 50% nitrous oxide or 30% oxygen: 70% nitrous oxide for 1 min. ⋯ Arterial oxygen saturations were continuously recorded by a separate investigator. All groups showed similar arterial desaturation during suxamethonium-induced apnoea and intubation, but the degree of desaturation was not clinically significant and no patient showed clinical signs of hypoxaemia. Preoxygenation with mixtures of oxygen and nitrous oxide can hasten the build-up of alveolar nitrous oxide concentration and help to smooth induction without compromising oxygenation of patients.