Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1980
Effect of 1% enflurane (Ethrane) anesthesia on cerebral blood flow and metabolism in neurosurgical patients during normo- and hyperventilation.
We have measured the CBF in ten neurosurgical patients. A first measurment was made during anesthesia with nitrous oxide 70% and a second with nitrous oxide 70% + 1% enflurane, both at a PaCO2 of 40 Torr. A third measurement was performed also with nitrous oxide + 1% enflurane, but at a PaCO2 of 30 Torr. ⋯ There were little differences in lactate and pyruvate cerebral metabolic rates, all values remaining within normal ranges. In conclusion, we believe that enflurane is a favorable anesthetic agent for neurosurgical operations at the concentration of 1%, CMRO2 is reduced, there is no significant effect on cerebral blood vessels, CBF and CVR do not change. However, a complementary use of hypocapnia may reduce CBF to dangerously low levels, if at the start, it shows already a pathological decrease and if hyperventilation is applied at a marked degree.
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Acta Anaesthesiol Belg · Jan 1980
Comparative Study Clinical TrialPediatric premedication: atropine or not?
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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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Acta Anaesthesiol Belg · Jan 1980
Comparative StudyA comparison between sodium nitroprusside and trimetaphan-induced hypotension.
Hypotension induced with nitroprusside is compared with the same degree of hypotension produced by trimetaphan in terms of cerebral perfusion, oxygenation and brain electrical activity. It is concluded that in all these respects nitroprusside has advantages over trimetaphan. On the other hand, nitroprusside increases intracranial pressure whilst trimetaphan does not. Both these drugs have a place in hypotension for neurosurgery.
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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.