摘要:

Eighteen healthy patients subjected to operation for duodenal ulcer were allocated randomly to one of two regimes of analgesic treatment with epidural morphine. The analgesic regime was started either per‐ or postoperatively. Epidural morphine in doses of 4 mg was given until satisfactory pain relief was achieved. Paco2and respiratory rate were measured hourly for 10 h and a nearly identical respiratory depression was found in the two groups. Peak Paco2‐‐values were seen in the 5th and 6th postoperative hour. The respiratory rate was initially high and declined during the first postoperative hours. Only one patient in each group had a pathologically low respiratory rate (8 min‐1), but this was transient and seen in thc 10th postoperative hour. The needs for epidural morphine on the first postoperative day were highest in the peroperative group. It is concluded that a peroperative start of pain treatment with epidural morphine does not affect the degree of respiratory depression or reduce the postoperative analgesic requi

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02444.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Fifty‐one patients scheduled for thoracotomy were included in a study involving five different methods of postoperative analgesia. Forty patients were randomly divided into: Group C, receiving intramuscular oxycodone on request following an intraoperative intercostal block; Group IC, intercostal blocks with 0.5% bupivacaine performed prior to surgery, 6 h later and on the first postoperative morning: Group EB, epidural bupivacaine as a continuous infusion of 0.25% bupivacaine (5 ml h‐1); Group EM4 epidural morphine 4 mg injected prior to surgery and on the first postoperative morning. In addition, a fifth group (Group EM6) of 11 patients received 6 mg of epidural morphine timed as in Group EM4, but these patients were automatically scheduled to be observed in the ICU. Additional intramuscular oxycodone was given on request to all patients. Group EB, EM4 and EM6 had lower numbers of requests than Group C. Pain intensity score was lowest (2.5 on a scale from 0 to 10, 3 h postoperatively) in Group EM6, and there was a statistically significant difference in pain intensity at 3 h between EM4 and EM6. The evaluation of cooperation and pain by the physical therapist revealed no differences between the groups. Postoperative blood‐gas analyses contained slightly elevated Pco2values (6.0–7.3 kPa) in all groups. Postoperatively, only Group EB was devoid of Pco2values above 7.3 kPa. Urinary retention was a common complication in the patients receiving epidural analgesia, occurring most frequently in Group EM6; 10 of the 11 patients had to be cathe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02445.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

In this study the effects of nicomorphine, administered either intramuscularly or by high thoracic epidural route, on the ventilatory and airway occlusion pressure response to CO2were investigated and compared. Twenty‐four patients scheduled for thoracic surgery were allocated randomly to postoperative pain relief by i.m. nicomorphine or by high thoracic epidural nicomorphine. The ventilatory response to 5% carbon dioxide was measured in all patients: first 1 day before operation, secondly on the first day after surgery immediately before nicomorphine administration and finally after the administration, at the moment when no further rise in end‐tidal Pco2(Petco2) was measured. Respiratory response was assessed in two ways, by measuring minute ventilation (Ve) and mouth occlusion pressure (p0.1). There was a significant depression in ventilatory response to CO2in the intramuscular group (P= 0.03) due to nicomorphine as assessed by the slope of Vevs PetCO2No significant depression was found in the epidural group, irrespective of measurement of VE, or P0.1. No significant shift of apnoeie threshold‐PETco2was observed in either

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02446.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Pulmonary ventilation, CO2response and inspiratory drive were studied during halothane anaesthesia prior to surgery in 13 spontaneously breathing infants less than 6 months of age. Pneumotachography and capnography were used. Airway and oesophageal pressures were measured and occlusion tests were performed at functional residual capacity. Measurements were made before and during 8 min of 4% CO2stimulation. Inspiratory drive increased significantly (P<0.001) at CO2stimulation. This resulted in increased minute ventilation (P<0.001) and tidal volume (P<0.001) while respiratory rate was unchanged. As VDBohr/VTratios were the same, the net effect was increased alveolar ventilation (P<0.001). CO2elimination was unpredictable in these young infants and decreased during CO2stimulation (P<0.05), while mean end‐tidal CO2concentration only increased from 5.2 to 6.3% (P<0.001). The ventilatory response to 4% CO2could therefore be deemed to be adequate during the short period (8 min) of CO2breathing. However, this was achieved at the cost of increased work as witnessed by the increased ratio between minute ventilation and CO2elimination (P<0.01). Stabilisation of end‐tidal CO2concentrations during CO2inhalation took only 10 s while the maximal increase in ventilation volumes was not achieved until after 150 s. It is concluded that young spontaneously breathing infants anaesthetized with halothane (MAC 1.3) have an increased respiratory drive with greater tidal volumes during CO2stimulations. Respiratory timing, dynamic compliance and total pulmonary resistance were, however, uninfluenced by 4% CO2stimulation. Increased monitoring of CO2output in anaesthetized infants is sugges

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02447.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A computerized non‐invasive strain gauge system for respiratory monitoring is described and compared with pneumotachography. With the use of simultaneous capnography, changes in breathing pattern, end‐tidal PCO2and CO2production were evaluated during non‐invasive (NIM) and invasive breathing monitoring (IM) in 14 healthy subjects. An overall absolute difference between measured and calculated tidal volumes of 4.6 ± 3.47% (r = 0.97) was found. When switching from NIM to IM, tidal volume increased by 19%, and breathing frequency decreased by 11% with a 10% increase in minute ventilation. These changes were mainly accomplished by an increased respiratory drive with the timing component unaltered. During IM both end‐tidal PCO2and CO2production increased significantly as compared with those du

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02448.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Eighty‐three children with a mean age of 2.7 years were anaesthetized with either thiopental 5 mg/kg followed by suxamethonium 1.5 mg/kg i.v. or with enflurane 5 vol% in 70% nitrous oxide in oxygen via a face mask. In the enflurane group, venepuncture was performed when the children were unconscious, 1.8 ±0.05 (s.e.) min after the start of anaesthesia. After enflurane, suxamethonium 1, 1.5 or 2 mg/kg was administered i.v. for endotracheal intubation. The incidence and duration of muscle fasriculations after suxamethonium were significantly lower (P<0.01) in the enflurane groups than in the thiopental group. The fasciculation index was significantly lower (P<0.01) in the enflurane groups than in the thiopental group. In the enflurane groups, intubating conditions were better (P<0.05) in the children treated with suxamethonium 2 mg/kg than in those treated with suxamethonium 1 mg/

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02449.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A prospective randomized study of 227 intravenous cannulae was undertaken to evaluate the effects of two different skin disinfectants before intravenous cannulation. Patients were divided into two groups. In one povidone‐iodine was used as disinfectant while in the other 70% isopropylalcohol was used. Intraluminal contamination rates, colony counts and organisms isolated are presented. We found no correlation between use of cannulae sideport and contamination. It was found that povidone‐iodine as a skin disinfectant reduced the intraluminal contamination from 22 to 7.25% (P<0.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02450.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The relation between left ventricular mean systolic pressure (LVSP) determined by planimetric integration and systolic and diastolic pressure measured in a peripheral artery (SAP and DAP) was calculated using data published by Ross&Braunwald in 1964. The relation was LVSP = SAP‐0.32 ± 0.06 (s.d.) × (SAP‐DAP). The formula SAP‐0.32 (SAP‐DAP) was used to calculated LVSP, and the correlation betwem measured and calculated LVSP was found to be 0.91 (P<0.001). It is concluded that LVSP can be calculated with reasonable accuracy from measurements of arterial pressure in patients without aortic stenosis. At present three different formulas are in use for the calculation of left ventricular stroke work index (LVSWI). The pressure work is defined as SAP, LVSP or mean arterial pressure minus mean pulmonary capillary wedge pressure or left ventricular end diastolic pressure. This makes comparisons between different studies with respect to LVSWI difficult or i

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02451.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

In 20 comatose patients (Glasgow coma scale ≤6 at admission) with severe head injury, the cerebral metabolic rate of oxygen (CMRo2) was calculated as the product of the hemispheric cerebral blood flow (CBF) and the arterio‐venous oxygen content difference (AVDo2). The hemispheric CBF was calculated by the intracarotid133xenon washout method by stochastic analysis as the average of 16 regions, and the measurements were performed within 3 weeks after the acute trauma. Generally no significant correlation (P<0.05) between CMRo2and CBF was found, either in the total number of paired observations, in studies of hyperaemia defined as CBF≥30 ml 100 g‐1min‐1;or in studies with reduced flow (CBF<30 ml 100 g‐1min‐1). However, in about 50% of patients subjected to repeated studies within days, CBF was positively correlated to CMRo2, and this correlation was observed independently of the CBF value. Hyperaemia was associated with a significant decrease in AVDo2, a significant increase in both absolute and relative CO2reactivity, and a significant increase in ventricular fluid pH; but not to an increase in intraventricular pressure, mean arterial blood pressure or significant changes in ventricular fluid lactate or lactatelp

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02452.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

One hundred and fourteen transcutaneous oxygen traces were obtained from 46 adults using a mass spectrometer. Such traces usually rise to a plateau about which they fluctuate. To estimate the plateau level, here called the asymptote, two models are described ‐ a time‐series model and a growth model. If ytis the trace measurement at time t, for the time‐series modelyt+l= m + α(yt‐m)+ε1, and for the growth modeldyt/dt = β(m‐yt),where parameters α and β represent the rate of approach to the asymptote m. Least squares estimates of these parameters were determined for every trace. For every trace, the estimated asymptotes are similar for both models but the other parameters show less agreement. Considering the traces for each person in pairs, each trace pair is allocated to one of four groups according as the traces were recorded on the same or different sites and on the same or different days. The correlation coefficient (r) between the estimated asymptotes is greatest for traces recorded on the same site and day (r>0.94,P0.71,P<0.001). The time series estimates of the asymptotr arc more credible than th

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1986.tb02453.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY