British journal of anaesthesia
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The haemodynamic indices of three patients, who developed abdominal tamponade as a result of intra-abdominal bleeding following liver transplantation, were measured on four occasions as the increased intra-abdominal pressure was released. Hypotension followed the release of the tamponade in all patients and was the result of a decrease in systemic vascular resistance. ⋯ Treatment of hypotension following release of abdominal tamponade by volume replacement alone may be inappropriate and may lead to over-transfusion; adrenaline may be the treatment of choice. Intensive haemodynamic monitoring is advisable.
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Randomized Controlled Trial Clinical Trial
Fentanyl and the beta-endorphin, ACTH and glucoregulatory hormonal response to surgery.
The effect of the supplementation of nitrous oxide-oxygen anaesthesia with either fentanyl 15 micrograms kg-1 or 0.5% halothane on the beta-endorphin, ACTH, glucoregulatory hormonal and metabolic response to pelvic surgery was investigated. Fentanyl inhibited the increases in circulating beta-endorphin, ACTH, growth hormone, cortisol and glucose concentrations found in the patients receiving halothane. Changes in circulating beta-endorphin concentrations during surgery probably reflect alterations in pituitary secretion and appear to have no major metabolic effects. The suppression of pituitary secretion persisted for at least 4 h after the start of surgery.
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Randomized Controlled Trial Clinical Trial
Effect of i.v. lignocaine on pain and the endocrine metabolic responses after surgery.
Pain intensity, and blood glucose and plasma cortisol concentrations were measured following abdominal hysterectomy in 18 patients allocated randomly to receive either i.v. lignocaine 1.5 mg kg-1 plus 2 mg kg-1 h-1, or saline. The administration of lignocaine resulted in plasma concentrations between 1.5 and 2.0 micrograms ml-1 during the 2-h study period. However, the administration of lignocaine i.v. had no effect on the intensity of pain after surgery, or on the adrenocortical and hyperglycaemic responses to surgery.
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Randomized Controlled Trial Clinical Trial
Quantitative EEG analysis during anaesthesia with isoflurane in nitrous oxide at 1.3 and 1.5 MAC.
In 14 patients undergoing elective surgery the EEG was studied during anaesthesia with isoflurane and nitrous oxide (in oxygen) at 1.3 and 1.5 MAC. The distribution of spectral EEG indices of the baseline EEG, during the intraoperative and recovery periods were established and compared. Median frequency exhibited the most clear separation between the distributions during recovery and the intraoperative period. ⋯ Burst suppression was observed during the loading period in all patients treated with 1.5 MAC and in five patients out of seven receiving 1.3 MAC. The average duration of the period of burst suppression was markedly greater in the group receiving 1.5 MAC than in the group receiving 1.3 MAC. It is concluded that devices designed for EEG trend monitoring during anaesthesia should preferably depict a frequency measure, and allow for burst suppression recognition before spectral analysis.
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A nationwide follow-up survey was undertaken to study the use of extradural and intrathecal opioids in the management of pain, to estimate the incidence of delayed ventilatory depression and to study post-injection surveillance routines. A questionnaire was sent to all 93 anaesthetic departments in Sweden; 96% responded. The major indication for using extradural opioids was the treatment of postoperative, traumatic and cancer pain. ⋯ Risk factors for delayed ventilatory depression are discussed. Administration of extradural morphine for postoperative pain relief in patients undergoing major surgery is considered a high benefit-low risk technique by most Swedish anaesthetists. The results of the present nationwide survey suggests that, following extradural morphine, surveillance of patients for more than 12 h appears unnecessary.