Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Dec 1982
Case Reports Randomized Controlled Trial Clinical Trialbeta-Receptor blockade and neurolept anaesthesia. Withdrawal vs continuation of long-term therapy in gall-bladder and carotid artery surgery.
Forty-eight chronically (greater than 3 months) beta-receptor-blocked patients with ischaemic heart disease and/or hypertension were studied on 49 occasions after random distribution to a 4-day, gradual preoperative withdrawal (n = 26) or a continuation (n = 23) of beta-receptor blockers. The patients were scheduled for either a cholecystectomy (n = 28) or a carotid thrombendarterectomy (n = 21) under neurolept anaesthesia. Three patients were excluded from the randomized part of the study due to complications (tachycardia, hypertension, severe angina) after therapy withdrawal. ⋯ Significantly more postoperative ECG changes (P less than 0.02) indicative of myocardial ischaemia were found than in beta-receptor blocked patients. These patients had low heart rates but also pronounced increases in pulmonary capillary wedge pressures, which in single patients could be associated with myocardial damage. These results imply that beta-receptor blockers should be continued before surgery and that a concomitant vasodilatatory therapy is likely to avoid the drawbacks of an increased cardiac afterload.
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Acta Anaesthesiol Scand · Oct 1982
Perivascular axillary block. I: blockade following 40 ml 1% mepivacaine with adrenaline.
Perivascular axillary block was performed on 80 patients by a catheter technique. All patients had a standard dose of 40 ml mepivacaine 1% with adrenaline. Thirty minutes after the injection, the motor and sensory blockade was determined. ⋯ Lack of analgesia was most often found in the cutaneous area of the axillary, musculocutaneous and radial nerves. The frequency of analgesia in the three areas of innervation was analysed with reference to the influence of the age, height and weight of the patient, and of differences in technique: paraesthesias, position of catheter, and unintended puncture of blood vessels. None of these variables seems to be important for the low frequency of analgesia in the three areas of innervation.
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Acta Anaesthesiol Scand · Oct 1982
Modification of ketamine-induced intracranial hypertension in neurosurgical patients by pretreatment with midazolam.
The effect on intracranial pressure (ICP) of ketamine as an anaesthetic induction agent following pretreatment with either midazolam (ten cases) or diazepam (five cases) was investigated in unpremedicated neurosurgical patients. In all patients in the midazolam group, ICP increased following ketamine while the cerebral perfusion pressure (CPP) fell in five cases. ICP rose further after intubation by a mean of 21 mmHg (2.8 kPa) with a further drop in CPP in two cases. ⋯ The mean increase in ICP following intubation was 6 mmHg (0.8 kPa) above control values. All patients required assisted ventilation after either benzodiazepine-ketamine combination. It is concluded that midazolam much more effectively suppresses the cardiostimulatory action of ketamine than the increase in ICP and that neither a midazolam-ketamine nor a diazepam-ketamine combination should be considered safe for use in patients who may have reduced intracranial compliance.
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Acta Anaesthesiol Scand · Oct 1982
Regional differences in lung function during anaesthesia and intensive care: clinical implications.
Anaesthesia and most frequently acute respiratory failure are accompanied by a lowered functional residual capacity (FRC). This lowering promotes airway closure in dependent lung units and forces ventilation to non-dependent regions. Perfusion, on the other hand, is forced towards dependent lung units. ⋯ Improved matching of ventilation and perfusion can be achieved by: (1) positioning the subject in the lateral posture; (2) ventilating each lung separately in proportion to its perfusion (differential ventilation); and (3) applying PEEP only to the dependent lung (selective PEEP). Because of less overall intrathoracic pressure and lung expansion, interference with the total lung blood flow and the danger of barotrauma should be less than with general PEEP. Improved gas exchange with a 50-100% increase in PaO2 has been observed in a limited number of patients with acute bilateral lung disease studied so far during differential ventilation and selective PEEP.
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Acta Anaesthesiol Scand · Oct 1982
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia and lung function: a comparison of intramuscular with epidural morphine.
Thirty healthy patients subjected to cholecystectomy or operation for duodenal ulcer were allocated randomly for postoperative analgesic treatment with morphine i.m. or epidurally. Morphine was given only at the request of the patients and only as much was given as was needed to obtain satisfactory pain relief. ⋯ Compared with the i.m. group, there was a higher arterial oxygen tension and a slower increase in alveolar-arterial oxygen difference. It is concluded that epidural morphine analgesia reduces the degree of postoperative lung dysfunction compared with conventional i.m. morphine treatment.