Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 1996
Introducing epidural fentanyl for on-ward pain relief after major surgery.
Epidural opioids have been recommended for analgesia after major surgery. In this report we describe how we introduced a low-cost, on-ward, nurse-based acute pain service using epidural fentanyl after major surgery in the University Hospitals of Oulu and Kuopio. ⋯ With well-trained nurses, careful monitoring and appropriate protocols, epidural fentanyl infusion proved to be a feasible method for pain relief after major surgery on a surgical ward.
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Acta Anaesthesiol Scand · Jul 1996
Local anaesthesia and propofol-fentanyl sedation for carotid artery surgery.
In patients undergoing carotid artery surgery with local anaesthesia (LA), a sedative/analgesic pharmacological supplement is appropriate in most cases in order to provide comfort. This adjunct should not preclude continuous clinical neurological monitoring. The aim was to investigate if a combination of fentanyl and propofol to supplement LA would provide comfort for the patient, allow continuous clinical neurological monitoring and absence of difficulties for the anaesthetist, and good conditions for surgery, including insertion of a shunt if this should become necessary. ⋯ The number of cases in this open, uncontrolled study does not permit an evaluation of this anaesthetic and sedative technique in terms of neurological and cardiac outcome. Thus, we simply want to inform about our positive experiences regarding patient acceptance and ease of performance in all relevant respects when fentanyl and propofol are used to supplement LA for carotid artery surgery.
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Acta Anaesthesiol Scand · Jul 1996
Case ReportsUse of the Univent System tube for difficult intubation and for achieving one-lung anaesthesia.
One-lung ventilation in major thoracic surgery is the most commonly accepted technique, not only for surgery on the lung but also in procedures involving the oesophagus, mediastinum and thoracic aorta. Conventional double-lumen tubes may sometimes be difficult to place correctly in patients in whom intubation is difficult. In such cases, the Univent System tube may be of help. It has a curved movable blocker of small calibre, and is designed to slide inside the bronchial tree and occlude all or part of the target lung. ⋯ Although the double-lumen tube is the first choice for one-lung ventilation, the Univent tube is a good option for selective bronchial intubation and in patients in whom difficult intubation is predicted.
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Acta Anaesthesiol Scand · Jul 1996
Serum protein binding of propofol in patients with renal failure or hepatic cirrhosis.
Serum protein binding is a limiting factor in the access of drugs to the central nervous system. Disease-induced modifications of the degree of binding may influence the effect of anesthetic drugs. ⋯ Due to the absence of significant changes in the protein binding it is unlikely that there will be an exaggerated pharmacological response in patients with renal and hepatic disease following the administration of a standard propofol dose, although due to interpatient variability careful titration can be recommended.
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Acta Anaesthesiol Scand · Jul 1996
Dural puncture: the patients' perspective. A patient survey of cases at a DGH maternity unit 1983-1993.
This study was designed to investigate the patient experience following accidental dural puncture complicating obstetric epidural analgesia. ⋯ Headache and backache are both common following dural puncture with a 16 G needle and both frequently recur after discharge from hospital. It was the strongly expressed opinion of this selected group that all mothers should be warned of the risk of dural puncture before undergoing epidural analgesia.