Langenbecks Archiv für Chirurgie
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Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (each 20 having undergone abdominal or orthopaedic operations). Pentazocine bolusses of each 8 mg were available via a hand-button whenever the patients felt pain relief necessary, and delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). ⋯ Side effects (nausea, emesis, sweating) occurred in about 10-18% but were usually of minor intensity. Circulatory or respiratory problems were not observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and clinical pain research.
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An indication for respiratory treatment is given in manifest and for prophylactic mechanical ventilation in expected pulmonal insufficiency. The mortality rate can be reduced by an early respiratory treatment, therefore prophylactic mechanical ventilation should be performed liberally. Mainly patients after abdomino-thoracal operations and major vascular or upper abdominal surgery are at risk for lethal postoperative pulmonary complications.
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In general there are two distinguishable methods of artificial ventilation: assisted spontaneous ventilation and controlled ventilation. Spontaneous ventilation can be supported by CPAP or PEEP, in order to improve oxygenation, and by IMV to improve CO2 elimination. ⋯ In special cases IRV may be applied. High frequency low pressure ventilation methods may be used intra- and postoperatively as well as post-traumatically.