Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Oct 1985
Continuous epidural analgesia for vaginal delivery in Sweden. Report of a nationwide inquiry.
Volumetric pump infusion of bupivacaine into the epidural space for pain relief during labour was introduced in Sweden in 1976. Since then the method has gained widespread use. A questionnaire concerning the use of epidural analgesia (EDA) in 1982 was sent to anaesthetists at all Swedish maternity clinics. ⋯ No complication which could be connected with infusion technique was noted. Maternal hypotension was rare and the instrumental delivery rate was low. The technique proved to be a valuable aid to the organisation of a 24-h service for obstetric analgesia, without requiring any increase in staff.
-
Acta Anaesthesiol Scand · Aug 1985
Infectious complications of percutaneously inserted central venous catheters.
The frequency of early and late complications of percutaneously inserted central venous catheters (CVC) was prospectively assessed. One hundred and fifty-one periods of catheterization (siliconized and heparinized polyethylene and teflon catheters), inserted mainly infraclavicularly and on the right side, were evaluated. Strict aseptic technique was used during insertion and daily care of the CVC. ⋯ Of 124 evaluated cases (96 arm-phlebography, 28 post-mortem) 16% developed thrombosis, and in one patient this probably resulted in fatal pulmonary embolism. Septicaemia was seldom seen: two cases were considered as proved and another two cases as probable. This study and other studies indicate that an aseptic technique is essential and perhaps even more important than using tunnelled versus percutaneously inserted catheters in respect of reducing infectious complications of central venous catheters.
-
Acta Anaesthesiol Scand · Aug 1985
Pain on i.v. injection of propofol (ICI 35 868) in emulsion formulation. Short communication.
Pain on injection of three anaesthetic induction agents, thiopentone, methohexitone and propofol (diisopropyl phenol), administered into a vein on the dorsum of the hand or wrist, was studied in 32 premedicated patients undergoing elective surgery. The pain was rated as none, mild or severe. ⋯ The pain was rated as severe more often in patients receiving propofol (67%, P less than 0.01 vs thiopentone) than in those anaesthetized with methohexitone (20%) or thiopentone (0%). It is concluded that the fat emulsion form of propofol, when injected into a peripheral vein, frequently induces severe pain.
-
Acta Anaesthesiol Scand · Aug 1985
Randomized Controlled Trial Clinical TrialEffect of aspiration of cerebro-spinal fluid on spinal anaesthesia with isobaric 0.5% bupivacaine.
The effect of changing the volume of cerebro-spinal fluid (CSF) before spinal anaesthesia with 3 ml of isobaric 0.5% bupivacaine was investigated in 60 elderly (58-77 years) orthopaedic or urological patients. The patients were randomly allocated to three groups. They received the spinal anaesthetic either with or without the aspiration of 3 ml of CSF. ⋯ The anaesthesia was satisfactory in most cases. One death occurred because of a massive pulmonary embolism. The clinical significance of aspirating CSF before attempting spinal anaesthesia with 3 ml of 0.5% isobaric bupivacaine was found to be small.
-
Acta Anaesthesiol Scand · Jul 1985
Etomidate anesthesia inhibits the cortisol response to surgical stress.
Plasma cortisol was measured in 18 patients undergoing gynecological procedures under etomidate or methohexital and nitrous oxide anesthesia. Plasma ACTH was also measured in three patients in each group. The mean plasma cortisol concentration before anesthesia was comparable in both groups. ⋯ The increase in plasma ACTH was equivalent in the two groups. Therefore, etomidate is a potent inhibitor of the adrenal response to surgery. The absence of clinical consequences associated with the blunted response suggests that a major increase in adrenal hormone production may not be necessary during surgery.