Acta anaesthesiologica Scandinavica
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The value of continuous transcutaneous oxygen tension (Ptco2) monitoring was assessed during the rapidly changing conditions of oxygenation associated with the commencement of one-lung ventilation (OLV) during thoracic surgery. In ten patients anaesthetized with enflurane-N2O (Fio2 0.5), Pao2, Ptco2, cardiac output and arterial pressure were measured first during two-lung ventilation (TLV) and thereafter at frequent intervals during OLV. These variables remained stable during TLV. ⋯ Ptco2 correlated well with Pao2 during OLV (r = 0.907). The elevated Ptco2 index (Ptco2/Pao2) may be partly due to the delayed response of the Ptco2-detection system in vivo. It is concluded that transcutaneous oxygen monitoring may be used to assess oxygenation in those cases where arterial cannulation is not feasible or if the laboratory conditions cause an undue delay between blood sampling and obtaining the blood-gas data.
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Forty-eight patients subjected to elective surgery were randomly selected for evaluation of neuromuscular transmission in the postoperative period. All patients were anaesthetized with thiopentone, nitrous oxide, fentanyl and pancuronium. On arrival in the postoperative ward, alertness, ability to sustain head lift and the train-of-four (TOF) ratio were estimated. ⋯ There was a poor correlation between TOF ratio and ability to sustain head lift. The study indicates that residual curarization is a not uncommon fact which clinically is hard to assess. The only wat to avoid residual curarization seems to be to monitor the neuromuscular transmission during anaesthesia.
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Acta Anaesthesiol Scand · Apr 1984
Effect of epidural morphine on post-operative pulmonary dysfunction.
The effect of post-operative epidural morphine analgesia on pulmonary function was assessed after abdominal surgery and compared to conventional analgesia. In a control group, ten patients received a parenteral analgesic, non-narcotic drug. In a second group of 11 patients, epidural morphine was injected after the operation and continuous analgesia was prolonged until the 3rd post-operative day by means of repeated injections through an epidural catheter. ⋯ Pain scoring documented a better analgesia in the epidural group during the post-operative period. By contrast, epidural morphine was unable significantly to improve VC, FEV1 and FRC during the post-operative course. The results suggest that pain is not an important factor of decreased post-operative pulmonary function.
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Acta Anaesthesiol Scand · Apr 1984
Randomized Controlled Trial Comparative Study Clinical TrialFailure of epidural analgesia to modify postoperative depression of delayed hypersensitivity.
Delayed hypersensitivity to four common antigens was assessed in 32 patients undergoing major abdominal surgery randomly allocated to either general anesthesia (fentanyl + O2/N2O + postoperative pain relief with systemic opiates) or general anaesthesia + epidural analgesia (local anaesthetics + morphine) continued for 72 h. Skin-test responses were performed 2 days before surgery and 1 day after surgery and compared to a similar retesting schedule in 16 comparable non-operative control patients. ⋯ In contrast, mean skin-test responses in patients operated during general anaesthesia + systemic opiates for postoperative pain relief fell from 1422 to 1227 mm2 (P = 0.3) and in patients receiving epidural analgesia from 1228 to 890 mm2 (P = 0.06), without statistically significant differences between these two groups (P greater than 0.5). Thus, surgery leads to depression of delayed hypersensitivity and this impairment in immunofunction is not modified by an epidural analgesic regimen providing adequate pain relief.
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Acta Anaesthesiol Scand · Apr 1984
Comparative StudyPain relief with epidural buprenorphine after spinal fusion: a comparison with intramuscular morphine.
In a prospective randomized trial, epidural buprenorphine was compared with intramuscular morphine for pain relief after spinal corrective surgery. Both forms of analgesia were given on demand and both produced excellent reduction of pain as assessed with visual linear analogue. The quality and duration of analgesia were similar for both groups of patients. Since the correct placement of epidural catheters could be done intraoperatively in difficult cases and since many patients for spinal corrective surgery have limited respiratory reserve, the authors feel that epidural buprenorphine provides an excellent alternative to conventional opiate analgesia after this type of surgery.