Articles: patients.
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Blood pressure monitoring · Apr 1998
Age-based differences between mercury sphygmomanometer and pulse dynamic blood pressure measurements.
Both the mercury sphygmomanometer and oscillometric measurement methods are widely in use for pediatric, adult, and geriatric patients. However, inherent differences between the methods of measurement may create varying degrees of sensitivity to age and potentially result in differences between measurements for these two techniques. DESIGN: Measurements of systolic and diastolic blood pressures in 154 subjects were obtained using the mercury sphygmomanometer and pulse dynamic oscillometric methods in accordance with the 1987 Association for the Advancement of Medical Instrumentation guidelines. Subjects were separated into three age groups and their data analyzed for differences between measurements for these two techniques. ⋯ The variation in the agreement of systolic blood pressure measurements can be attributed to the differing effects of age-dependent arterial changes on the measurement methods. The findings indicate that, although the pulse dynamic oscillometric method and mercury sphygmomanometer correlate well when patients of all ages were evaluated as a group, agreement between measurements of systolic blood pressure is dependent on age and the method of measurement employed.
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Curr Opin Anaesthesiol · Apr 1998
Fluid replacement for hypotensive injury victims: how, when and what risks?
Intravenous fluid administration is considered universally indicated for patients with post-traumatic hypotension of presumed hemorrhagic origin, regardless of the mechanism of injury, anatomic location, and whether hemostasis has been achieved. This premise is based primarily on animal studies in which blood loss results from a controlled catheter withdrawal. However, more recent hemorrhage models that incorporate a vascular injury, as well as recently completed clinical trials, have indicated that attempts to restore blood pressure before surgical hemostasis may have the undesirable effects of accentuating hemorrhage and mortality.
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There is no reliable method to relieve both 'refractory' pain and spasticity in patients with multiple sclerosis (MS). This paper reports on the long-term use of continuous intrathecal bupivacaine infusion in such a patient. The patient under study was a 56-year-old woman affected for 18 years by MS, unsuccessfully treated with analgesics, baclofen, opioids, peripheral neurolysis (obturator nerves, lumbar plexus) and six intrathecal neurolyses of the L4-S3 nerve roots, each time with 1.5 ml of 50% phenol in glycerol. ⋯ The treatment was given for 712 days, at which point the patient died (unrelated to the treatment). Intrathecal infusion of bupivacaine relieved 'refractory' spasticity and pain in a MS patient in whom administration of intrathecal baclofen was contraindicated and neurodestructive procedures had been inefficient. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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In the present article, the relationships between pain, coping, functional capacity and psychological well-being are examined in a population of older patients (>/=60 years; n=202) treated for a variety of somatic complaints in a university-affiliated hospital. Results indicate that moderate to extreme pain is common in older patients and often occurs in several body regions simultaneously. Extreme pain in one or more body regions is associated with reduced daily functional capacity, lower values for life satisfaction and self-evaluated competence, and more negative attitudes towards the present and future. ⋯ Results of a hierarchical cluster analysis reveal interindividual differences in coping approaches among older patients suffering from extreme pain; they also emphasize the importance of cognitive strategies and life-review coping. Relevance for clinical practice with older pain patients is discussed. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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The transdermal therapeutic system (TTS) for fentanyl is a drug-delivery system for use in patients with chronic pain who require an opioid analgesic. A multicentre, randomized, double-blind, placebo-controlled study was performed to evaluate the efficacy and safety of TTS-fentanyl as an analgesic for chronic cancer pain. One hundred and thirty-eight patients entered a 15-day dose-titration period, followed by a 9-day double-blind period (95 patients) with TTS-fentanyl or placebo. ⋯ Due to an unexpectedly high placebo response it was not possible to demonstrate fentanyl to be statistically superior to placebo. This may reflect the practical difficulties of performing clinical trials in cancer patients with great inter-individual variability. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.