Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1991
Percutaneous placement of permanent central venous catheters: experience with 200 catheters.
The prospective registration of 200 percutaneous placements of permanent central venous catheters (Hickman catheters and subcutaneous infusion ports) was conducted in 172 patients aged 3 months-95 years. The insertions were reviewed to assess whether certain groups of patients or physicians were associated with more complications than others. Complications occurred in 16 patients (8.0%), of which 12 were arterial punctures. ⋯ Percutaneous placement of permanent central venous catheters thus proved to be a safe and reliable technique, even in small children. The method is easily learnt by physicians experienced in central venous catheterization. Using this method, permanent venous access may be offered to a large number of patients.
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Acta Anaesthesiol Scand · Nov 1990
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialEffect of epidurally administered bupivacaine on atracurium-induced neuromuscular blockade.
The effect of epidurally administered bupivacaine on duration, intensity and reversal characteristics of atracurium-induced neuromuscular blockade was studied in 30 healthy patients anaesthetized with thiopentone, fentanyl, midazolam and nitrous oxide. Fifteen patients received, in addition, epidural anaesthesia with bupivacaine. The remaining patients served as controls. ⋯ Post-tetanic count (PTC) after 20 min was also significantly lower in the epidural group (P less than 0.05). It is therefore concluded that epidurally administered bupivacaine prolongs atracurium-induced neuromuscular blockade. The clinical implication of the modest prolongation is, however, limited.
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Acta Anaesthesiol Scand · Nov 1990
Randomized Controlled Trial Clinical TrialClonidine premedication: a useful adjunct in producing deliberate hypotension.
The effect of clonidine on the dose requirements of labetalol and isoflurane for hypotension was studied in 20 adult patients undergoing middle-ear surgery. Group I (10 patients) received as premedication only pethidine 1 mg.kg-1 i.m., and Group II (10 patients) clonidine 4-5 micrograms.kg-1 p.o. in addition to pethidine. Fentanyl was used for analgesia and d-tubocurarine for muscle relaxation. ⋯ Urine flow rates (UF) were lower in Group II (0.23 +/- 0.04 ml.min-1) than in Group I (0.68 +/- 0.16 ml.min-1) before hypotension (P less than 0.05) and during hypotension (0.08 +/- 0.02 ml.min-1 vs. 0.68 +/- 0.32 ml.min-1, P less than 0.05). After anaesthesia, there was no difference in UF between the groups. The results indicate that clonidine can be used for deliberate hypotension to decrease the dose requirements of labetalol and isoflurane.
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Acta Anaesthesiol Scand · Nov 1990
The use of a laryngeal mask airway in spontaneously breathing patients.
The Laryngeal Mask Airway (LMA) is a new type of oropharyngeal airway that provides an alternative to endotracheal intubation and standard mask anaesthesia in certain cases. Once the patient is adequately anaesthetised, it can be inserted blindly, without recourse to laryngoscopy or muscle relaxants. ⋯ Postoperative problems were minimal and 97.6% of our patients said that they would prefer a similar anaesthetic in future. LMA does not guarantee against the risk of aspiration and it is not recommended for use in patients who may have a full stomach.
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Acta Anaesthesiol Scand · Nov 1990
Pressure pain thresholds in volunteers and herniorrhaphy patients.
Pressure algometry is a method to estimate pressure pain sensitivity in tissues. The aim of the present study was to evaluate the reproducibility of pressure pain thresholds (PPT) in the abdominal integument and to evaluate the use of pressure algometry as a measure of wound tenderness following surgery. PPT was determined in 20 healthy volunteers on two separate examinations, and in 14 patients at the incisional site before and following inguinal herniotomy. ⋯ In surgical patients a significant decrease in PPT was observed following operation. Morphine 0.07 mg/kg caused a slight but significant increase in PPT. Pressure algometry may be useful to study nociceptive mechanisms and the dynamics of wound pain in surgical patients.