Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2001
Clinical TrialLong-term outcome after neurosurgically treated spinal epidural abscess following epidural analgesia.
A recent investigation demonstrated a high incidence of epidural abscess secondary to epidural catheterization and a 50% frequency of neurologic deficits. We studied short- and long-term neurologic outcome in patients operated for spinal epidural abscess after epidural analgesia. ⋯ Overall recovery rate for patients with paresis/plegia after epidural abscess was 20%. No patients with paresis/plegia following a thoracic abscess recovered in contrast to a 50% recovery rate for patients with lumbar epidural abscess. The majority of long-term survivors had severe neurologic deficits. Abscess formation contributed to one death.
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Acta Anaesthesiol Scand · Feb 2001
Randomized Controlled Trial Clinical TrialEpidural fentanyl markedly improves thoracic epidural analgesia in a low-dose infusion of bupivacaine, adrenaline and fentanyl. A randomized, double-blind crossover study with and without fentanyl.
The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief, and side effects when removing fentanyl from an optimally titrated epidural infusion consisting of bupivacaine, fentanyl and adrenaline. ⋯ A low dose of epidural fentanyl (20 microg x h(-1)) markedly improved the pain-relieving effect of bupivacaine and adrenaline infused epidurally at a thoracic level after major upper abdominal surgery. This dose of fentanyl is much too small to relieve severe dynamic pain when given systemically. Therefore, this study indirectly supports the view that a low-dose thoracic epidural infusion of fentanyl has a spinal analgesic site of action.
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Acta Anaesthesiol Scand · Feb 2001
Meta AnalysisAn increased body mass index is no risk factor for postoperative nausea and vomiting. A systematic review and results of original data.
An increased Body Mass Index (BMI) is almost always mentioned as a fundamental risk factor for postoperative nausea (PN), vomiting (PV) or both (PONV). However, multivariate analyses were unable to detect any correlation. Therefore, we asked whether an increased BMI is really a risk factor for PONV. ⋯ Systematic search of the literature provides no evidence for a positive relationship. Furthermore, our data confirm that an increased BMI is not a risk factor for PONV. This negative finding is important as focussing on the relevant risk factors is needed to allow for an objective risk assessment of PONV.
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Acta Anaesthesiol Scand · Feb 2001
Review Case ReportsNo pain relief from codeine...? An introduction to pharmacogenomics.
Drug treatment remains a mainstay of medicine. In some situations a drug unexpectedly has no effect, or unforeseen serious side effects occur. For the patient this represents a dangerous and potentially life-threatening situation. ⋯ Modern biotechnology would be unthinkable without the aid of computers, and we briefly touch upon the field of bioinformatics. Finally, we give an overview of pharmacogenomics in the narrower sense. The rapidly growing field of pharmacogenomics is going to influence our everyday practice of medicine in the immediate future.
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Acta Anaesthesiol Scand · Feb 2001
Case ReportsCesarean section under epidural ropivacaine 0.75% in a parturient with severe pulmonary hypertension.
Pregnancy and delivery are a potentially lethal combination in a patient with primary pulmonary hypertension. There are controversies regarding mode of delivery. Cesarean section is considered to be associated with extensive perioperative risks. ⋯ Vaginal delivery was excluded since her cervix was too immature for succesful induction. This is the first reported case of its kind to receive an epidural anesthesia with ropivacaine with its potential advantage of a low cardiac toxicity. The epidural was slowly and carefully titrated to give a stable anesthesia with good quality.