Acta anaesthesiologica Scandinavica
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Peripheral airway pressure (Pp) was measured during high frequency ventilation (HFV) (open system) (1-20 Hz) by retrograde catheters in eight excised dog lungs. Central airway pressure (Pc) and pleural pressure (Ppl) were measured simultaneously. ⋯ With increasing tidal volume Pc, Pp, and Ppl (mean) increased at all frequencies. The increase in end-expiratory pressure indicates an "auto-PEEP" effect, which may contribute to the better gas exchange described during HFV.
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Acta Anaesthesiol Scand · Jan 1986
Perivascular axillary block VI: the distribution of gelatine solution injected into the axillary neurovascular sheath of cadavers.
Axillary perivascular injection of 50 ml blue-stained gelatine was made in 20 cadavers, and a total dissection of the axilla was performed. The distribution of injected gelatine and the contact between nerves and gelatine were examined on cross-sections of the neurovascular bundle. The spread of gelatine was characterized by: restriction of gelatine to the neurovascular bundle, an upper border of the gelatine which was constantly found to be proximal to the coracoid process, and bulging of the gelatine towards the medial part of the axillary space. ⋯ The median and the ulnar nerves were in all dissections found to be in direct contact with the gelatine, whereas the radial, the musculocutaneous, and the axillary nerves did not always have direct contact with the gelatine. Abduction of the arm to 90 degrees brings the stretched neurovascular bundle close to the lateral wall of the axilla and this compromises perivascular circumferential spread of the injected gelatine. On the basis of the present investigation, it is hypothesized that insufficient circumferential spread is the cause of incomplete axillary blockades, and the perivascular injection of local anaesthetic should consequently be made with the arm along the side of the body.
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Acta Anaesthesiol Scand · Nov 1985
Circulatory changes during high thoracic epidural anaesthesia--influence of sympathetic block and of systemic effect of the local anaesthetic.
Circulatory changes during high thoracic epidural anaesthesia (TEA) were studied in nine healthy volunteers by means of echocardiography and systolic time intervals. The subjects also underwent a physical work test with bicycle ergometry. To evaluate the systemic effect of the local anaesthetic (bupivacaine), the same subjects were investigated 3 weeks later when a corresponding dose of the local anaesthetic was injected intramuscularly instead of epidurally. ⋯ Following i.m. injection of bupivacaine, SV decreased 8% and CO 20%. The pre-ejection period/left ventricular ejection time ratio increased 23% during TEA and 16% after i.m. injection. The results indicate that the circulatory changes did not seem to be caused entirely by the cardiac sympathetic block, but were due partly to the systemic effect of bupivacaine.
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Acta Anaesthesiol Scand · Nov 1985
Randomized Controlled Trial Comparative Study Clinical TrialA controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery.
A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low-dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4-S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P less than 0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. ⋯ Postoperative weight loss and decrease in serum-albumin and serum-transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self-aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the above-mentioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.
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Five dogs were cooled externally with ice-bags to rectal temperatures of 21.8-24.8 degrees C. Rewarming was performed with a specially constructed double-lumen oesophageal tube with circulating water at 42 degrees C. With this device, rewarming of the dogs to 30 degrees C took place in 60-102 min (mean 82 min). ⋯ The efficiency of this rewarming method is comparable to that of peritoneal dialysis. No after-drop in temperature was observed and there were no other complications during these experiments. Rewarming with an oesophageal thermal tube is very simple and safe to use.