Acta anaesthesiologica Belgica
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An anterior approach to the block of the sciatic nerve is described. The procedure has been applied in over 780 patients. It is quick, simple, safe and free from any serious complications.
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Postoperative pain relief is only apparently an easy task. A brief survey of literature investigating the discomfort experienced in the postoperative phase is all but encouraging. ⋯ An alternative strategy introducing "On-Demand" analgesia administering prescribed doses at the right moment is presented and analysed a) as an operant conditioning process implementing a particular reinforcement schedule (behavioural sciences), as well as b) a negative feedback control loop that entrust the central judgement to the patient (system theory). Both approaches give insight into the results: the technique copes with biological variability; anticipating pain induced by fear disappears; the feedback strategy works well and patients adapt to a wide range in prescriptions; intermittent administration makes more efficient use of the analgesic; an optimal result is demonstrated in studies comparing on-demand analgesia with the normal IM-regime and epidural analgesia; continuity in pain relief can be obtained in routine clinical practice.
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The use of analgesic drugs is only one part of a multidisciplinary approach which offers also other possible palliative procedures for pain therapy. Pain complaints are placed against the background of terminal illness. ⋯ The way of adminstration may have some impact on the efficacy of the analgesic regimen. Side effects and concomitant medication are reviewed.
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Acta Anaesthesiol Belg · Jan 1980
Controlled administration of oxygen with self inflating resuscitation bags.
Resuscitation bags were originally developed to ventilate patients under emergency conditions. Under circumstances where oxygen is available one should make full use of it. The problem of exact air enrichment for these bags has not been satisfactory solved until now. ⋯ This is obtained via a venturi device connected to the air inlet of the manual resuscitation bag. The FIO2 delivered to the patients from a self inflating bag was tested for values of 24, 30, 40 and 50% oxygen. The new system proved to be capable to delivery exact FIO2 in contrast with previously applied methods of oxygen delivery where this could never be achieved.
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Acta Anaesthesiol Belg · Jan 1980
Monitoring of blood coagulation in open heart surgery. II. Use of individualized dosages of heparin and protamine controlled by activated coagulation times.
Results are presented of individualized anticoagulatory management during open heart surgery in two groups of 20 patients comparing colloid versus non-colloid priming of the extracorporeal circuit. Advantages of individualized dosages of heparin according to a constructed dose response curve and controlled by measuring Activated Coagulation Times (ACT) were safer adaptation to individual variability in heparin sensitivity, reduction of incremental heparin doses during cardiopulmonary by-pass and nearly 50% reduction of protamine dosage as compared to conventional heparinprotamin protocols. No significant influence of the type of priming used in the extracorporeal circuit on coagulatory behaviour could be detected.