Articles: function.
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There is a great need to expand current knowledge of the various functional capacity measurements used in the rehabilitation of chronic low back pain (CLBP) patients. The literature on these patients reports that mobility, endurance, trunk strength and lifting capacity decrease during the process of chronicity. Chronically disabled patients appear to have lower functional capacity than asymptomatic persons. ⋯ Study results showed that physical capacity in disabled patients with low back pain is substantially reduced in comparison to persons who do not suffer from back pain. The only exception was in trunk flexor strength and endurance, in which measurements did not differ between the patients and the control group. However, even CLBP- patients with long-term pain and severe physical illness can successfully improve their physical condition by participating in an active treatment program. Back extensor muscle training has to be included in physical therapy. Because of loss of condition during the time after treatment, regular monitoring of patients and their home training programs is necessary. Overall, treatment of CLBP has to include physical training and psychosocial treatment to achieve satisfactory results.
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Journal of anesthesia · Sep 1996
Clinical evaluation of a new continuous intraarterial blood gas monitoring system in the intensive care setting.
The present study was designed to evaluate a new continuous intraarterial blood gas monitoring system under routine clinical intensive care conditions. Nine mechanically ventilated adult patients were enrolled in this study. A multiparameter intravascular sensor was inserted into the radial or dorsalis pedis artery through a 20-gauge cannula in each patient. ⋯ In clinically important ranges of Po2, less than 200 mmHg in particular, the bias and precision values were -2.25±6.48 mmHg in the range of less than 100mmHg, and 0.98±14.38 mmHg in the range of 100-200 mmHg. Variations of sensor accuracy as a function of elapsed time were within the clinically acceptable range throughout the study period. These findings suggest that this new device is sufficiently useful for routine clinical settings.
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Journal of anesthesia · Sep 1996
Neuromuscular effects of sevoflurane in patients with myasthenia gravis.
The current study evaluated the neuromuscular responses following administration of sevoflurane in 14 patients with myasthenia gravis (MG) (I-IIb in Osserman's classification) scheduled for thymectomy and in 11 control patients (ASA I-II) who underwent elective surgery. The electromyographic (EMG) response of the abductor digiti minimi was measured following train-of-four (TOF) stimulation of the ulnar nerve every 20 s. After induction of anesthesia with a combination of 3-4 mg·kg(-1) thiopental and 1-2 μg·kg(-1) fentanyl with 66% N2O and oxygen, an inspired concentration of 4% sevoflurane was administered via a face mask for 7 min. ⋯ On the other hand, no notable changes were observed in patients with normal neuromuscular functions. The most significant factor that correlated with the depression of the TOFR values induced by 1 MAC sevoflurane was the anti-AchR antibody titers (P=0.029). Our results indicate that MG patients have an increased neuromuscular sensitivity to sevoflurane.
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Journal of anesthesia · Sep 1996
Flumazenil does not antagonize the cardiac effects of midazolam in the isolated rat heart-lung preparation.
We examined the effects of midazolam and flumazenil on cardiac function and metabolism in the isolated rat heart-lung preparation. Wistar rats were divided into five groups (each group:n=8) as follows: (1) control (saline); (2) flumazenil (1.3×10(-5)M); (3) flumazenil (10(-4)M); (4) midazolam (60μg·ml(-1)); and (5) midazolam (60μg·ml(-1)) and flumazenil (1.3×10(-5)M). Systolic blood pressure and calculated left ventricular dP/dt maximum in the midazolam or midazolam conbined with flumazenil groups increased significantly in comparison with those in the control group. ⋯ There were no significant differences in the myocardial tissue concentration of ATP, lactate, and glycogen in all groups. In this study, midazolam decreased heart rate; however, flumazenil had no effect on the heart, nor did it antagonize the cardiac effects of midazolam. These results suggest that flumazenil has no effect on the peripheraltype benzodiazepine receptor of the myocardium.
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A multimodal treatment program is presented in cases of functional restoration for chronic low back pain. The study comprises four parts. Part I gives an overview of the different results of the study. Part II focuses on the medical and functional examination in comparison with persons who do not suffer from back pain. Part III describes psychosocial aspects (depression, complaints, ways of coping, disability) and psychotherapy. In part IV prognostic factors and their reliability for predicting treatment outcome (return to work, pain intensity, self-assessment of success by patients) are examined. In addition the relevant effects of the program on social and health care systems are also addressed. ⋯ The results demonstrate the effectiveness of the multimodal program of functional restoration, not only concerning positive changes in somatic, psychological and physical variables, but also with respect to the number of patients who returned to work. Our methods are also compared with the discrepant results of multimodal treatment in the United States and Scandinavia.