Acta anaesthesiologica Scandinavica
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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.
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Acta Anaesthesiol Scand · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialVentilatory effects of epidural clonidine during the first 3 hours after caesarean section.
Many authors have shown the analgesic efficacy of 150-800 micrograms of epidural clonidine in the postoperative period. Its use as an analgesic after caesarean section has recently been studied with higher dosages (400-800 micrograms). Our study aimed at assessing the analgesic and ventilatory effects of two smaller doses of epidural clonidine (150 and 300 micrograms), which were compared to the effects of 10 mg of parenteral morphine (M) during the first 3 h after caesarean section. ⋯ Arterial blood pressure decreased from 30 min after the injection to the end of the study in both epidural clonidine groups. A marked sedation was observed in patients receiving 300 micrograms of epidural clonidine and was frequently associated with snoring, obstructive apnoea and episodes of arterial oxygen desaturation. We conclude that 150 micrograms of epidural clonidine provides better and longer analgesia after caesarean section than 10 mg of parenteral morphine, and seems preferable to higher doses (300 micrograms) in this setting, since 300 micrograms of epidural clonidine may produce unacceptable respiratory obstructive disturbances.
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Acta Anaesthesiol Scand · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialSublingual premedication with brotizolam.
This randomized, double-blind and double-dummy study was carried out in order to compare the perioperative sedation after premedication with either brotizolam 0.25-0.50 mg sublingually or diazepam 5-10 mg orally. Sixty-two patients aged 18-60 years scheduled for minor gynaecological surgery in general anaesthesia were included. Assessments were: 1. auditory continued response time (ACRT); 2. coma scale; 3. anxiety scale; and 4. final patient questionnaire. ⋯ The final questionnaire showed (P < 0.05) that the brotizolam group was more satisfied with the effect of the premedication. Seven hours after the premedication the ACRT scores in both groups were similar to those before premedication and all the patients could walk about freely. In conclusion, as a premedicant in outpatients sublingual brotizolam appears to be a good alternative to diazepam.
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Acta Anaesthesiol Scand · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialClinical and metabolic responses to different kinds of premedication in ASA III patients.
Clinical and metabolic responses to atropine plus pethidine and to scopolamine plus morphine premedication were studied in 45 ASA physical status III patients undergoing gynaecological procedures. Atropine 0.5 mg plus pethidine 50 mg intramuscularly (Group 1), scopolamine 0.24 mg plus morphine 8 mg (Group 2), or intramuscular placebo (Group 3) premedication were given in random, double-blind fashion. Scopolamine-morphine premedication caused a significant decrease in energy expenditure (EE) and oxygen consumption (VO2) (from 1229 +/- 193 to 1184 +/- 221 kcal/24 h, P = 0.004 and from 105 +/- 11 to 102 +/- 12 ml/min/m2, P = 0.006, respectively) simultaneously with a decrease in rate-pressure product (RPP) (P = 0.0001) and an increase in pressure-rate quotient (PRQ) (P = 0.034). ⋯ The degrees of subjective tiredness and anxiolysis were significantly greater in Groups 1 and 2 (showing good sedative and anxiolytic effect) than in Group 3. These results show that in ASA III patients, atropine-pethidine premedication does not decrease the sympathoadrenal reaction to the degree its anxiolytic and sedative effect would suggest. This may indicate neuroendocrine stress induced by atropine-pethidine.
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The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. ⋯ However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)