Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1987
Randomized Controlled Trial Comparative Study Clinical TrialCryoanalgesia for post-thoracotomy pain relief.
A randomized study comparing the postoperative requirements of narcotics of three groups of patients (Group I: no analgesia; Group II: internal intercostal nerve block; Group III: cryoanalgesia) was conducted. This study was performed in order to assess the efficiency of cryoanalgesia versus internal intercostal nerve block to obtain pain relief after thoracotomy. Regarding post-operative narcotic requirements (Piritramide-Dipidolor), there was no significant difference between Group I and Group II patients, but patients from Group III required a significantly lower amount of narcotics during the first 36 postoperative hours (p less than 0.01). We conclude that, although cryoanalgesia does not provide complete post-thoracotomy pain relief, it is however an easy and safe method and is more efficient than internal intercostal nerve block for pain relief after thoracotomy.
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Acta Anaesthesiol Belg · Jan 1987
ReviewResuscitation and evaluation of victims of blunt multisystem trauma.
The initial management of hemodynamically unstable polytrauma patients can be challenging. Although there are other possible causes of hypotension, such as tension pneumothorax, CNS injury and hemopericardium, in the vast majority of blunt trauma victims shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clearcut, the rapid identification and control of the bleeding source may not be a straightforward matter. ⋯ In concert with respiratory management, other members of the trauma team should secure adequate vascular access, resuscitate the patient and perform a physical examination. Physical findings dictate the order of further diagnostic and therapeutic maneuvers. In unstable patients the potential need for urgent surgical intervention must not be overlooked.
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After a brief review of the supraspinal and spinal effects of morphine, the reference substance for studies on analgesia, the authors expose a synthesis of the recent literature regarding neurotransmitter involvement in pain perception and transmission. From these data, some future prospects for pain treatment research are identified.
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During a consecutive period of 24 months, 244 patients with a major trauma were admitted to the Intensive Care Unit. From this pool of patients 60 consecutively were selected who did fulfill the selected criteria. ⋯ We could conclude that no currently used diagnostic test may be seen as an accurate prediction of patients who still develop morbidity or mortality from cardiac contusion. Data from the literature suggest that at present only radionuclide angiography, direct hemodynamic measurement with construction of a Starling curve, and/or 2D-echocardiography may be useful in the identification of the patients at the greatest risk and predictive of the severity of the myocardial injury.