Acta anaesthesiologica Scandinavica. Supplementum
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Acta Anaesthesiol Scand Suppl · Jan 1988
ReviewSedation by the use of inhalation agents in dental care.
Nitrous oxide/oxygen has long been the mixture of gases used in dental practice to produce light sedation. The main indication for use of nitrous oxide/oxygen sedation is fear-anxiety. The equipment used is a continuous flow machine with a fail safe system set at a minimum of 30 or 40 per cent oxygen. ⋯ Side effects, e.g. restlessness, vomiting, and nausea are infrequent. About 90 per cent patients, who have difficulty in co-operating during dental treatment, mainly because of anxiety, show excellent or fair co-operation during nitrous oxide/oxygen sedation. Occupational exposure to nitrous oxide can be minimized by the use of scavenging systems, local exhaust systems, careful sedation technique, and equipment management.
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Acta Anaesthesiol Scand Suppl · Jan 1988
ReviewImmunosuppressive effects of blood transfusion in anaesthesia and surgery.
The immunosuppressive effects of blood transfusion at surgical operations become manifest as enhanced graft survival, increased cancer recurrence and decreased patient survival, and increased susceptibility to postoperative infections. Blood transfusion in transplant recipients no longer offers this advantage when cyclosporine A is used. ⋯ Leucocyte-free red blood concentrates are the least immunosuppressive homologous blood preparations. Conventional red blood cell concentrates may also be used in cancer patients until ongoing prospective randomized studies confirm that there is a true association between the use of homologous blood and increased recurrence of cancer.
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From a survey of the recent literature on chronic intraspinal morphine administration for cancer pain concerning 412 cases, the present authors observe that: 1. data regarding follow-up on pain relief and complications are lacking; 2. continuous administration by closed systems shows more efficacy in long-term pain relief; 3. tolerance, although not reported by all authors, is present and becomes remarkable in prolonged administration; 4. serious side-effects are less frequent with the epidural administration technique. These data are confirmed by the present authors' clinical experience of 22 patients treated with epidural morphine administration and 53 patients treated with intrathecal morphine. The widespread use of these methods is limited not only by technical complications but also by the existence of certain types of pain which do not respond to morphine and which may develop, as part of the evolution of the neoplastic disease, even during treatment with intraspinal morphine.
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The clinical evaluation of continuous administration of epidural morphine was undertaken using an infusion pump (Act-A-Pump 1000). Eleven patients who had undergone abdominal surgical procedures were treated with this therapeutic modality for postoperative pain control, and two cancer patients for chronic pain relief. The results were satisfactory and the advantages over repeated epidural injections are discussed.