Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialImmediate and prolonged effects of pre- versus postoperative epidural analgesia with bupivacaine and morphine on pain at rest and during mobilisation after total knee arthroplasty.
Thirty-two patients scheduled for total knee arthroplasty were randomized to receive an identical epidural blockade initiated 30 min before surgical incision (N = 16), or at closure of the surgical wound (N = 16). Before induction of general anaesthesia the epidural catheter was tested with bupivacaine 7.5 mg.ml-1, 2 ml. General anaesthesia was induced with thiopentone, pancuronium or atracurium, and fentanyl 0.1-0.3 mg, and maintained with N2O/O2 and enflurane. ⋯ Paracetamol 1000 mg every 8 h was administered from 48 h to 7 days postoperatively. No significant differences were observed in request for additional opioids, or in pain scores at rest or during mobilisation of the operated limb, during or after cessation of the epidural regimen. These results do not suggest timing of analgesia with a conventional, continuous epidural regimen to be of major clinical importance in patients undergoing total knee arthroplasty.
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialEfficiency of a new radiant heater for postoperative rewarming.
Effective rewarming devices have only become available recently. This investigation compares the efficiency of an new overhead radiant heater (ARAGONA Thermal Ceilings TM, CTCX, 1000 W) with that of an electric blanket (50 W) or a standard hospital blanket. 35 patients undergoing postoperative assisted ventilation and continued sedation were randomly assigned to one of the treatments. Shivering, oxygen uptake, heart rate and invasive blood pressure were measured and the increase in total body heat minus body heat production was calculated as heat balance. ⋯ A slightly positive heat balance was only achieved in the group treated by radiant heat, indicating that all metabolic heat was conserved or heat losses were compensated by transfer of external heat. Shivering was significantly reduced in the radiant heater group whereas the rate pressure product was insignificantly higher. We did not find any significant effect for the electric heating blanket in comparison to the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Clinical TrialAddition of atracurium to lidocaine for intravenous regional anaesthesia.
This study was undertaken to examine the possible clinical advantages of using muscle relaxant with intravenous regional anaesthesia, (IVRA). Forty unpremedicated adult patients undergoing hand surgery were randomly allocated to receive either 40 ml 0.5% lidocaine or 40 ml 0.5% lidocaine with 2 mg of atracurium. ⋯ Clinically, there was no difference in the speed of onset of block between the two groups. It is concluded that the addition of atracurium to lidocaine improves the operating condition during IVRA with less pain during and after surgery.
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialEffects of fentanyl or alfentanil as supplement to propofol anaesthesia for termination of pregnancy.
One hundred and twenty patients undergoing early legal termination of pregnancy by dilatation and suction curettage before 12 weeks of pregnancy were randomly allocated to receive total intravenous propofol anaesthesia either alone or supplemented with fentanyl 1.5 micrograms.kg-1 or alfentanil 15 micrograms.kg-1. Supplementation with fentanyl or alfentanil improved operating conditions (P < 0.01), reduced total propofol requirements (P < 0.01) and reduced postoperative pain intensity (P < 0.05). ⋯ In conclusion, total intravenous propofol anaesthesia in patients undergoing early termination of pregnancy was improved by supplementation with either fentanyl 1.5 micrograms.kg-1 or alfentanil 15 micrograms.kg-1. The benefit was slightly greater with alfentanil than with fentanyl.
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Acta Anaesthesiol Scand · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialIsosorbide dinitrate does not interfere with heparin anticoagulation: a placebo-controlled comparison with nitroglycerin in patients scheduled for coronary artery surgery.
The possible nitrate-induced heparin resistance was studied intraoperatively in 40 patients undergoing coronary artery bypass grafting. The patients were randomized to receive a continuous infusion of placebo, nitroglycerin (0.5 microgram kg-1 min-1) or isosorbide dinitrate (0.5 or 2.5 micrograms kg-1 min-1). After the infusion had been administered, prior to the institution of cardiopulmonary bypass, for at least 60 min, porcine intestine heparin 300 I. ⋯ U. kg-1, respectively) was administered to achieve systemic anticoagulation. Activated coagulation time values and plasma heparin anti-X, activity showed no significant differences between the groups before and after the administration of heparin. It is concluded that in doses given in the present study, organic nitrates do not interfere with the anticoagulation effect of large doses of heparin required for the conduction of cardiopulmonary bypass.