Articles from Acta anaesthesiologica Scandinavica. Supplementum

Acta Anaesthesiol Scand Suppl · Jan 1987

Drug delivery systems for epidural administration of opioids.

From a practical and cost-effective viewpoint, the bolus administration of opiates via an implanted epidural catheter and portal injection system offers improved pain control for a good percentage of patients suffering pain secondary to cancer who are not responding to oral analgesia. However, considerable research is required into the mechanism of action, drug of choice, and optimal drug delivery system for the epidural administration of opiate drugs. Although this system is still in its infancy, it would be fair to say that it is one of the most significant advances for the control of pain in patients with cancer this century.

Pathophysiology of shock-induced disturbances in tissue homeostasis.

A survey is given on disturbances in tissue homeostasis induced by hypovolemic shock conditions. Fluid shifts taking place between the extra- and intravascular fluid compartments are important early compensatory responses following hypovolemia. Usually the supply-to-demand ratio of oxygen in most tissues can however, not be kept up if the hypovolemic insult is severe due to deterioration of the microcirculation. ⋯ Thereby reactions leading to severe complications such as adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and multiple organ failure may be started. The aim of shock treatment should be to reverse as rapidly and as efficiently as possible the pathophysiological disturbances induced by a shock state. If the cellular hypoxic insult can be limited then the incidence of systemic complications in the post-shock period will also be reduced.

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Acta Anaesthesiol Scand Suppl · Jan 1985

Review

Rationale for the use of colloids in the treatment of shock and hypovolemia.

The question, "Are colloids or crystalloids to be preferred for resuscitation in hypovolemic shock conditions?" is detailed in this review. The effects of these two types of fluid regimes on restitution of circulating blood volume, interstitial rehydration, microvascular blood flow, cellular metabolic recovery and on the incidence of systemic complications such as adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and multiple organ failure are considered. ⋯ Colloids do not seem to adversely affect pulmonary function. Dextran has considerable advantages over other types of colloids for the initial shock treatment due to its antithrombotic properties whereby cell aggregability is prevented and the incidence of systemic complications (microembolism syndromes) is convincingly reduced.