Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1996
Randomized Controlled Trial Clinical TrialPotentiation of atracurium by pancuronium during propofol-fentanyl-N2O anesthesia.
At the end of abdominal surgery deep neuromuscular blockade is required for peritoneal closure. Ideally injecting an intermediate acting drug like atracurium after a long acting drug such as pancuronium should deepen the neuromuscular block without the fear of an inadequate reversal at the completion of surgery. Thirty patients ASA I or II status, without known allergy to myorelaxant and without neuromuscular, hepatic or renal failure were included in this study. ⋯ Electrolytes and acid-base status were similar between groups at the beginning of surgery. Thus this study shows a synergistic effect of the combination of atracurium after pancuronium occurring in non hypothermic patients anesthetized without halogenated agents. Because the duration of action of the drug administered first governs the duration of action of the subsequent neuromuscular myorelaxant, the neuromuscular function should be closely monitored at the end of surgery if neuromuscular drugs are used in combination.
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Acta Anaesthesiol Belg · Jan 1996
Randomized Controlled Trial Clinical TrialEffects of three techniques of lung management on pulmonary function during cardiopulmonary bypass.
In this study, 30 patients undergoing elective myocardial revascularization were divided randomly in three groups (10 patients each) with different management of the lungs during CPB: Group 1, lungs deflated; Group 2, static inflation with PEEP = 5 cmH2O and FIO2 = 1.0; Group 3, static inflation with PEEP = 5 cmH2O and FIO2 = 0.21. Measurements (Qs/Qt, P(A-a)O2, PaO2, Cstat, Cdyn, PIP, AUTO-PEEP, Rrs,max, Rrs,min and DRrs) were performed after the induction of anesthesia (T0), 20 minutes (T1) and 2 hours (T2) after the end of CPB. Respiratory mechanics data were obtained only at T0 and T2 because the sternal retraction. ⋯ The comparison between the groups showed a significant minor impairment of gas exchange (PaO2 and P(A-a)O2), Qs/Qt and Cstat in the third group of patients. These results show that lungs inflation with air during CPB, effectively preserve respiratory system mechanics: this might be due to a preservation of bronchial perfusion simply due to the mechanic expansion of the lung otherwise compromized when the lungs are completely collapsed. However it is necessary to emphasize that CPB has negative effects on gas-exchange whatever technique of lung management is used.
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Ketorolac is an efficient drug for the treatment of moderate to severe pain following minor or intermediate types of surgery. Its use is associated with improved quality of recovery, reduced incidence of side effects and earlier discharge from the recovery unit and the hospital in patients treated on an ambulatory basis. ⋯ However, it is an effective adjunct to all forms of opioid analgesia being associated with a significant opioid sparing effect. Large scale studies have demonstrated that this combination of improved analgesia and opioid sparing is of clinical benefit.
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Acta Anaesthesiol Belg · Jan 1996
ReviewPain relief and clinical outcome: from opioids to balanced analgesia.
If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts should aim at including physical rehabilitation programs in the pain treatment regimen.
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Acta Anaesthesiol Belg · Jan 1996
Comparative Study Clinical Trial Controlled Clinical TrialA comparison of the laryngeal mask and tracheal tube for controlled ventilation.
The use of laryngeal mask airway (LMA), size 3 or 4, and endotracheal tube (ETT) 8.0 mm was studied comparatively to determine the adequacy of respiratory function during positive pressure ventilation (PPV) by applying a series of given peak inspiratory pressures (PIPs) of 10.0, 12.5, 15.0, 17.5, 20.0 and 30.0 cm H2O. Eleven anesthetised patients underwent a double comparative trial. ⋯ Higher values of VT (1.7 mk.kg-1) were expired via the LMA compared with ETT when a given PIP of less than 20 cmH2O was applied. LMA as opposed to ETT secured normocapnia during PPV with low PIPs.