Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 1988
Randomized Controlled Trial Comparative Study Clinical TrialRespiratory effects of nitrous oxide during halothane or enflurane anaesthesia in children.
The respiratory effects of nitrous oxide (N2O) were studied during halothane and enflurane anaesthesia in 12 children (mean age 46.4 +/- 29.3 months, mean weight 15.3 +/- 4.2 kg) during surgery under continuous extradural anaesthesia. Four equipotent anaesthetic states were studied in random order: 1) halothane 1 MAC in oxygen, 2) halothane 0.5 MAC + 50% N2O, 3) enflurane 1 MAC in oxygen, 4) enflurane 0.5 MAC +50% N2O. End-tidal fractions of CO2 (PetCO2) and halothane and enflurane were measured using infrared analysers. ⋯ During enflurane anaesthesia, PetCO2 was less increased when N2O was substituted for enflurane, owing to a significant increase in respiratory frequency. A marked decrease in VE together with an increase in PetCO2 was observed during enflurane anaesthesia (states 3 and 4) when compared to the corresponding states during halothane anaesthesia (states 1 and 2). The respiratory depressant effect of enflurane is greater than that of halothane in unpremedicated children, even when substituting N2O for an equal MAC fraction of enflurane.2+ The effect of N2O on respiratory patterns seems to depend on the inhalational agent used and/or on the vesting respiratory frequency.
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Acta Anaesthesiol Scand · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialOpioid treatment for radiating cancer pain: oral administration vs. epidural techniques.
In order to determine the optimal pain treatment for patients with cancer involvement of the brachial or lumbar nerve plexuses, a prospective comparative study was carried out using peroral opioid therapy (SO), epidural opioid by a conventional tunnelled epidural catheter (CE) or an epidural catheter connected to an implanted injection port (Port). Pain relief, measured by a visual analog scale (VAS), was similar and adequate in every group already after the first 24 h. CNS side-effects were less frequent and the Karnofsky performance grades slightly superior in the epidural groups. ⋯ Both epidural techniques seem suitable for long-term pain therapy. Technical improvements are needed in the epidural catheter and the port. The long-term epidural catheter does not seem to cause any major changes in the histology of the dura mater or the connective tissue of the epidural space.
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Acta Anaesthesiol Scand · Apr 1988
Clinical experience of long-term treatment with epidural and intrathecal opioids--a nationwide survey.
Long-term use of spinal opioids to treat chronic severe pain is widely established. However, the indications, shortcomings and complications of the method have not been completely described. Experience with spinal opioids was analysed for the period 1979-1984 in a nationwide Swedish survey. ⋯ Initial results were considered "excellent" in 11 departments, but at follow-up results were excellent in only one department. In addition to dislocation, occlusion of the catheters or leakage, injection pain was an obstacle to successful treatment. Pruritus urinary retention, and local infections were not reported as significant problems, but one case of meningitis was reported.
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Acta Anaesthesiol Scand · Apr 1988
Hydroxyethyl starch 120, dextran 70 and acetated Ringer's solution: hemodilution, albumin, colloid osmotic pressure and fluid balance following replacement of blood loss in pigs.
Twenty healthy pigs weighing 12-17 kg were anesthetized and the small intestines were exteriorized into saline-moistened gauze. During a 2-h period 4% of the animals' body weight was bled through an arterial cannula in six increments and replaced immediately by the fluid tested: hydroxyethyl starch 120 (HES, Plasmafusin, Orion Corp., Mw 120,000), dextran 70 (DEX) and Ringer's acetate (RA). The amount of fluid infused for replacement of blood loss was equal to the amount of blood withdrawn in the colloid groups but fourfold in the RA group. ⋯ The RA animals were unable to excrete the excess crystalloid, which resulted in a strikingly positive fluid balance persisting throughout the study. Thus, the synthetic colloids were superior to RA in expansion of the plasma volume, maintenance of the COP and prevention of fluid accumulation. The effect of the two colloids was similar except that COP was slightly better maintained during the follow-up period in animals which received HES 120.
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Acta Anaesthesiol Scand · Apr 1988
Randomized Controlled Trial Comparative Study Clinical TrialCardiac function and sympathoadrenal activity in the newborn after cesarean section under spinal and epidural anesthesia.
Left ventricular systolic time intervals, bupivacaine concentrations, adrenaline and noradrenaline levels were determined in 19 neonates delivered by elective cesarean section. Ten of the cesarean sections were performed under spinal and nine under epidural anesthesia. ⋯ The differences in catecholamine and bupivacaine concentrations were not associated with differences in left ventricular dynamics, or the timing of postnatal circulatory changes. The significant exposure of the neonate to bupivacaine, at maternal epidural anesthesia, seems to have no negative effect on early neonatal circulation in the healthy term infant.