European journal of anaesthesiology. Supplement
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Good analgesia does not normalize post-operative pulmonary function but is important in allowing measures such as post-operative physiotherapy to be applied following major abdominal or thoracic surgery. Clinical studies have generally failed to duplicate animal work on the effectiveness of pre-emptive analgesia possibly because the nociceptor stimuli persist as long as there is wound pain. Anaesthetic techniques which include sensory blockade are associated with a lower incidence of several post-operative complications and this improvement is more marked in high-risk patients. ⋯ There is no evidence that multimodal 'balanced' analgesia offers any advantages in terms of improved outcome or reduction in adverse events. Whilst sophisticated methods for providing post-operative pain relief, such as PCA and PCEA, are highly effective, they are appropriate for only a minority of surgical operations. An Acute Pain Service can delivery a traditional intermittent opioid regime effectively at relatively low cost.
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Constant and episodic hypoxaemia are common after major operations in the late post-operative period in the surgical ward. Recent studies have shown that hypoxaemia may be related to the development of myocardial ischaemia and cardiac arrhythmias. ⋯ Finally, mental confusion and surgical delirium may be related to inadequate arterial oxygenation during the late post-operative period. Late post-operative constant and episodic hypoxaemia may therefore be important surgical risk factors, and further studies on the pathogenesis, prophylaxis and treatment are warranted.
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Eur J Anaesthesiol Suppl · Jan 1994
Comparative Study Clinical Trial Controlled Clinical TrialEvaluation of the effects of rocuronium bromide on haemodynamics and left ventricular function in patients undergoing abdominal aortic surgery.
In an open study of 26 patients undergoing abdominal aortic surgery, the effects of rocuronium 0.6 mg kg-1 (eight patients) and 0.9 mg kg-1 (nine patients) were compared with those of pancuronium 0.085 mg kg-1 (eight patients) on haemodynamic parameters and transoesophageal echocardiography. The anaesthetic technique was based on a benzodiazepine and low dose fentanyl (6 micrograms kg-1). Pancuronium was associated with a significant increase in mean arterial pressure, end-diastolic area and heart rate, none of which were seen after rocuronium at either dose level.