摘要:

A ventilator converter device (Anmedic) for connecting a non‐rebreathing ventilator (Servo Ventilator 900 B; Siemens‐Elema) to a circle anaesthesia system was evaluated in a lung model. Recorded minute ventilation was slightly lower than dialled in most cases. We furthermore found inadequate expiratory expansion of the ventilator converter bellows, with progressive loss of tidal volume and consequently recorded minute volume, when fresh gas flow to the circle system was low (1 l±min‐1), expiratory time was short (<40%) and respiratory obstruction was p

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03426.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The relationships between self‐reported assessments of the quality of the preoperative night's sleep, preoperative anxiety, and several biochemical and physiological indicators of stress reaction were investigated in pregnant women at term receiving no premedication (n = 15), a placebo tablet (n = 15), diazepam 5 mg p.o. (n = 15), or atropine 0.01 mg/kg i.m. (n = 15), in connection with spinal analgesia for elective caesarean section. In the patients receiving no premedication, the subjective estimate of the quality of the preoperative night's sleep was negatively associated with concentrations of noradrenaline (NA) and its metabolite, 3‐methoxy‐4‐hydroxyphenylglycol (MHPG) in CSF, and with plasma adrenaline. The anxiolytic effect of diazepam was reflected as significantly lower plasma levels of another metabolite of NA, 3,4‐dihydroxyphenylglycol (DHPG). Placebo and diazepam, and to a lesser extent atropine, confounded the statistical relationships between the clinical and biochemical responses found in the patients with no premedication. On the whole, the biochemical monoamine measurements were of little use in determining the clinical effects of different kinds of pre

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03427.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The effect of labetalol on deliberate hypotension was studied in 24 adult patients undergoing middle‐ear surgery. Hypotension was induced in Group I (12 patients) with isoflurane 3.0 vol% in inspiratory gas, and in Group II (12 patients) with labetalol 0.5 mg±kg‐1i.v., in addition to isoflurane. The induction time of hypotension was 4.9±1.0 (s.e. mean) min in Group I, and 1.8±0.2 min in Group II (P<0.01). The mean isoflurane concentration in inspiratory gas for the maintenance of hypotension was 1.4±0.2 vol% in Group I, and 0.7±0.1 vol% in Group II (P<0.01). There were no differences in urine flow rates (UF) between the groups during any phase, though UF decreased in Group I from the prehypotensive value 0.58±0.12 ml±min‐1to 0.07±0.02 ml±min‐1during hypotension (P<0.01) and increased to 1.28±0.17 ml±min‐1after anaesthesia (P<0.05). UF in Group II were 0.56±0.17, 0.25±0.10 and 0.56±0.06 ml±min‐1, respectively. Creatinine clearances per 1.73 m2body surface area (CCreat) in Group I were 78±14 ml±min‐1, and in Group II 78±11 ml±min‐1before hypotension. During hypotension, CCreatwere lower in Group I (8±1 ml±min‐1) than in Group II (33±8 ml±min‐1) (P<0.01). After anaesthesia, there was no difference in CCreatbetween the groups (Group I: 110±17 ml±min‐1and Group II: 120±17 ml±min‐1). The results indicate that labetalol has a favourable effe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03428.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A questionnaire concerning the treatment of cancer pain was sent to 10% and 5% random samples of Finnish physicians in 1985 and in 1990, respectively. The physicians were asked about their current practice in the treatment of pain in their cancer patients, and about their main clinical problems when treating pain. Three simulated patient cases were presented, and the adequacy of the suggestions for therapy was evaluated. The results indicated that Finnish physicians had adopted a more rational and effective analgesic therapy during the 5‐year period. Treatment suggestions for the simulated patient cases had improved both in terms of daily doses of analgesics and of dose intervals, but the doses of opioids were still below those commonly used in chronic cancer pain. The clinical difficulties experienced by the physicians had changed: instead of being frustrated by the inefficacy of their treatment as in 1985, physicians were now working on the problem of finding a suitable preparation and dosage. The results suggest that the voluntary activity of patient organizations, a few pain clinics, and a few clinicians interested in pain treatment have been able to improve the practising physicians' theoretical knowledge in 5 years. In contrast to the improvement in the knowledge and skills, changing attitudes takes much longer. As many as 39% of physicians who see cancer patients at least occasionally, reported that they still had not acquired the prescription sheets necessary to prescribe opioids to outpatient

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03429.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

In order to evaluate postoperative pain treatment following thoracic surgery, 214 medical records of patients who were operated during 1986–1988 were examined. Nurses' comments concerning pain and the amounts of analgesics given during the 2 postoperative days were recorded. The 150 patients who were still alive in December 1989 were sent a postal questionnaire which asked about the pain and the efficacy of pain relief they had received after their operation. They were also asked if they still had pain which they connected to the thoracotomy and if any attempts had been made to treat that pain. The mean consumption of intramuscular oxycodone was 38 mg during the 1st and 33 mg during the 2nd postoperative day. The administration of nonsteroidal anti‐inflammatory drugs significantly reduced the opioid consumption on the second but not on the first postoperative day. In 30% of the patients' charts there were no remarks on pain, in 10% there was a mention of no pain, in 40% pain was mentioned and in 20% the patient was reported to have severe pain. During the first postoperative week little pain was experienced by 60% of the patients, considerable pain by 35% and excruciating pain by 5% of the patients being interviewed. The postoperative pain relief was rated as good in 60% of the answers, satisfactory in 38% and poor in 2%. Persistent post‐thoracotomy pain lasting for more than 6 months was reported by 44% of the patients, of whom 66% had received treatment for the

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03430.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

We studied the effects of elective hip surgery, performed under either spinal (SA, n = 10) or general anesthesia (GA, n = 10), on breathing pattern and gas exchange. Measurements were made with respiratory inductive plethysmograph and indirect calorimetry in two positions before and after surgery. The method of anesthesia had no effect on the severity of postoperative hypoxemia. Reduced arterial oxygenation (Pao2;P<0.001, SA from 12.5±2.37 kPa to 10.5±1.38 kPa, GA from 12.5±2.95 kPa to 10.5±1.75 kPa) despite increased alveolar ventilation (P<0.01; from 2.30±0.37 1/min to 2.39±0.43 1/min in SA, 2.27±0.56 1/min to 2.57±0.35 1/min in GA) and reduced arterial carbon dioxide partial pressure (Paco2; SA from 5.20±0.22 kPa to 4.95±0.33 kPa,P<0.01, GA from 5.07±0.36 kPa to 4.72±0.41 kPa,P<0.05) indicated maldistribution of ventilation and perfusion. Changes in breathing pattern and gas exchange and differences between the groups were minimal. Minute ventilation, tidal volume and mean inspiratory flow remained unchanged in both groups. The contribution of rib cage to tidal volume increased postoperatively in the supine position (P<0.001; SA from 32.6%±10.3 to 46.3%±7.5, GA from 36.5±16.4 to 48.5%±15.4). CO2production, oxygen consumption and energy expenditure remained unchanged. The postoperative changes in breathing pattern are related to the operation, not to the type of anesthesia and do not explain the alterations

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03431.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Two patients with acute severe asthma, who failed to respond to conventional therapy, were given intravenous ketamine in sub‐anaesthetic doses with good results. A bolus dose of 0.75 mg/kg was followed by the same dose over 10 min with relief of bronchospasm in both cases. An infusion of ketamine at a rate of 0.15 mg/kg/h was used in each case to prevent recurrence of bronchospasm. Intravenous ketamine can be used to relieve acute intractable bronchospasm provided expert anaesthetic help is at hand. A review of the literature concerning its use in such situations is also presente

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03432.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY