Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 1995
Recovery from neuromuscular blockade: residual curarisation following atracurium or vecuronium by bolus dosing or infusions.
We conducted a survey of the incidence of Postoperative Residual Curarisation (PORC) in two groups of patients following the use of atracurium or vecuronium. In the first group (B) the neuromuscular blocking drugs were administered by bolus dosing, and in the second group (I) by continuous fusion. On arrival in the recovery room, neuromuscular function was assessed both by compound evoked electromyogram (EMG) in a train of four pattern and also clinically, by the ability to sustain a headlift for > 5 seconds, and to cough. ⋯ Clinical criteria of adequate neuromuscular reversal revealed different results, with the majority of patients being unable to perform either clinical test on arrival in recovery. Those patients in whom a peripheral nerve stimulator was used intra-operatively did not have a reduced incidence of PORC. We have demonstrated that PORC is still a common occurrence even with intermediate duration of action neuromuscular blocking drugs.
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Acta Anaesthesiol Scand · Apr 1995
Case ReportsThe laryngeal mask simplifies airway management during percutaneous dilational tracheostomy.
The Laryngeal Mask Airway (LMA) is used for many procedures which previously required endotracheal intubation. Percutaneous Dilational Tracheostomy (PCT) facilitates the bedside insertion of a tracheostomy tube in the Intensive Care Unit. ⋯ Insertion of a LMA has advantages over tracheal intubation for PCT mainly because the artificial airway lies remote from the operating field. Three cases are reported to illustrate these advantages.
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Acta Anaesthesiol Scand · Feb 1995
Randomized Controlled Trial Clinical TrialReplacement of major surgical blood loss by hypo-oncotic or conventional plasma substitutes.
The purpose of the study was to examine the effects of hypooncotic 4% hydroxyethyl starch 120/0.7, 3% dextran 70, 5% albumin and hyperoncotic 6% hydroxyethyl starch 120/0.7 on the perioperative colloid osmotic pressure (COP), albumin and protein concentrations and fluid balance. The plasma substitutes were used with red cell concentrates to replace blood loss with equal volume in sixty major abdominal or urological surgeries. A special effort was made to keep replacements and losses at even volumes constantly and to avoid fluctuation of blood volume. ⋯ During the observation period there were no significant differences among the groups concerning the diuresis and the fluid balances. We conclude, that the hypooncotic 4% HES 120 and 3% dextran 70 solutions provide the same clinical effect as 6% HES 120 solution. Consequently less colloid is needed, which allows the use of greater volumes of the dilute colloid solutions in replacement therapy.
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Acta Anaesthesiol Scand · Feb 1995
Randomized Controlled Trial Comparative Study Clinical TrialIntramuscular ketorolac following total hip replacement with spinal anaesthesia and intrathecal morphine.
We have studied the analgesic and morphine sparing effect of ketorolac tromethamine in 60 patients after total hip replacement under spinal anesthesia. In this double blind study 30 patients received ketorolac 30 mg IM 6 hourly postoperatively and the control group received saline. Analgesia was assessed by visual analogue pain scores (VAS) and morphine consumption by patient controlled analgesia (PCA). ⋯ Although there was a trend for lower VAS on the first postoperative night this was only significant at 10 hours postoperatively and the next morning at 08:00 hr. The incidence of side effects (emetic sequelae, pruritus and headache) were similar in both groups. It is concluded that ketorolac reduces the consumption of additional morphine in conjunction with intrathecal morphine but had no effects on the side effects.
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Acta Anaesthesiol Scand · Feb 1995
Randomized Controlled Trial Clinical TrialEffect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy.
The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1-2 patients undergoing elective laparoscopic cholecystectomy. The patients were randomly selected (20 patients in each group) to receive in double-blind fashion 100 mo of either plain 0.15% bupivacaine (150 mg.100 ml-1) or the same solution with adrenaline (1.5 micrograms ml-1), or the same volume of saline into the right subdiaphragmatic space at the end of surgery. The patients were kept in the Trendelenburg's position for 20 min after the instillation. ⋯ In all groups, 30-45% of the patients complained of right shoulder pain. After the first 24 hours, pain at rest and during moving was reported as mild and was managed with oral ketoprofen. It is concluded that postsurgical intraperitoneal instillation of 150 mg bupivacaine in 100 ml of saline had no effect on pain after laparoscopic cholecystectomy.