Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1995
Randomized Controlled Trial Clinical TrialIntra-arterial regional anaesthesia for hand surgery with alkalinized 0.5% lignocaine.
Intra-arterial regional anaesthesia (IARA) for hand surgery is an old, forgotten technique. One of the causes of low popularity may be a scalding sensation in the hand during intra-arterial injection of lignocaine, which may be caused by low pH of lignocaine's solution. In this randomized, double-blind study, normal (pH 5.2-5.3) or alkalinized (pH 7.2-7.3) preservative-free 0.5% lignocaine 1.5 mg kg-1 was injected into the radial arteries of forty adult patients to produce anaesthesia for ambulatory hand surgery. ⋯ Nine patients in group 1 and seven in group 2 developed minor bruises after cannulation (NS). No other sequelae of intra-arterial injections were observed. We conclude that alkalinized 0.5% lignocaine was less painful on injection than normal lignocaine and should be preferred for intra-arterial anaesthesia for hand surgery.
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Acta Anaesthesiol Scand · Nov 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of preoperative with postoperative topical lidocaine spray on pain after tonsillectomy.
Seventy-five children aged 4-6 years scheduled for tonsillectomy were randomly allocated to receive either topical tonsillar spray with 10% lidocaine 4 mg kg-1 3 minutes before surgical incision; identical tonsillar spray after both tonsils had been removed; or no topical spray (control group). There were significant differences in postoperative pain between the lidocaine groups and the control group at 0.5 and one hour after awaking (P < 0.05). ⋯ Topical lidocaine seemed to have short-acting analgesic activity. The results of this study do not support the theory of pre-emptive analgesia.
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Acta Anaesthesiol Scand · Nov 1995
Randomized Controlled Trial Clinical TrialEffect of succinylcholine on subsequently administered mivacurium in children.
The interaction between mivacurium and succinylcholine when mivacurium was administered during the early recovery from succinylcholine block was studied in 30 children 2-12 years of age anaesthetized with propofolalfentanil-N2O-O2. Neuromuscular response was monitored by adductor pollicis EMG. Fifteen patients received 200 micrograms.kg-1 of mivacurium (Group M), and another fifteen received 1500 micrograms.kg-1 of succinylcholine followed by 200 micrograms.kg-1 of mivacurium when the first EMG response recovered to 5% of calibration value (Group SchM). ⋯ Times required for recovery of the first EMG response from 25 to 75% of full EMG recovery were 3.6 +/- 1.0 (mean +/- SD) and 4.0 +/- 0.7 min for the Groups M and SchM, respectively. The time from administration of mivacurium to the recovery of train-of-four ratio 0.70 was 13.2 +/- 3.3 min for the Group M and 13.6 +/- 3.1 min for the Group SchM (NS). Thus, in patients with normal pChE activity preceding administration of succinylcholine did not influence the recovery of neuromuscular function from subsequent mivacurium.
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Acta Anaesthesiol Scand · Nov 1995
Effect of continuous positive airway pressure (CPAP) in patients with chronic obstructive pulmonary disease (COPD) depending on intrinsic PEEP levels.
The application of continuous positive airway pressure (CPAP) is known to reduce inspiratory work of breathing in intubated patients with chronic obstructive pulmonary disease (COPD). This effect is caused by a decrease in elastic work related to a reduction in intrinsic PEEP. The aim of this study was to relate the decrease in inspiratory work due to CPAP to the intrinsic PEEP levels obtained during spontaneous breathing without positive pressure. ⋯ This decrease was found to be related to the intrinsic PEEP-levels; the largest reductions were found in the patients with an intrinsic PEEP-level close to the CPAP-level applied. In intubated patients with COPD, the decrease in Wltot due to a CPAP of 0.5 kPa was found to be related to the intrinsic PEEP-levels present when no positive airway pressure was applied. The intrinsic PEEP measured during tracheal occlusions could be used to estimate the effect of CPAP in these patients.
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Thoracic paravertebral nerve blockade, although once widely practised, has now only a few centres which contribute to the literature. Data production has, however, continued and this review correlates this new information with existing knowledge. Its history, taxonomy, anatomy, indications, techniques, mechanisms of analgesia, efficacy, contraindications, toxicity, side effects and complications are reviewed. ⋯ For unilateral surgery of the chest or truck, thoracic paravertebral analgesia should be considered as the afferent block of choice. For bilateral surgery, its efficacy may be limited by the doses of local anaesthetic which could safely be used and further study in this area in particular is required. This form of afferent blockade deserves greater consideration and investigation.