摘要:

In a double‐blind study, intubating conditions and haemodynamic responses were assessed in two age‐groups of 45 ASA I‐II children, with mean ages of 2.4 and 6.3 years, premedicated with oral midazolam and atropine. The children were randomly allocated to one of three groups: aifentanil 20 μg · kg‐1+ lidocaine 1 mg · kg‐1(AIRO + Lign); alfentanil 20 μg μ kg‐1(Alf20); or alfentanil 40 μg · kg‐1(Alf40), followed by propofol 3.5 mg · kg‐1in the children aged 1–3 years and 3.0 mg · kg‐1in the older children. Intubating conditions, 40 s after the administration of propofol, were assessed as good, moderate or impossible on the basis of jaw relaxation, ease of insertion of the endotracheal tube and coughing during intubation. In the younger age group the frequencies of good, moderate or impossible intubating conditions were 87, 13 and 0% in the Alf40, 40, 60 and 0% in the Alf20 (P<0.05 compared to the Alf40 group) and 53, 47 and 0% in the Alf20 + Lign group. In the older age group the corresponding frequencies were 60, 33 and 7% in the Alf20 + Lign, 47, 53 and 0% in the Alf20 and 47, 40 and 13% in the Alf40 group. All the drugs prevented any increase in arterial pressure and heart rate after tracheal intubation. The QTc interval of the EGG was always in the normal range. Clinically important bradycardia did not occur. In conclusion, the best intubating conditions occurred after propofol 3.5 mg · kg‐1and alfentanil 40 μg · kg‐1in the younger age group. In the other children good or moderate intubating conditions occurred in 87–100% after al

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03798.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A comparison was made between early and late recovery after major abdominal surgery under intravenous anaesthesia with propofol (with and without nitrous oxide) or inhalational anaesthesia with isoflurane. Sixty patients were randomly allocated to one of three forms of anaesthesia: propofol, propofol/nitrous oxide, or isoflurane/nitrous oxide anaesthesia. All received fentanyl and vecuronium. Recovery was monitored during the first 2 h after extubation and on days 1, 2, 3, 7 and 30 after surgery. Every 30 min during the first 2 postoperative hours, the Steward recovery scale, sedation, orientation, collaboration, and comprehension were assessed by a blinded observer. Psychomotor function was evaluated by computerised simple reaction time and finger tapping speed in 32 patients. A scale of symptoms and mood check list were filled in by 35 patients on days 1, 2, 3, 7 and 30. The preoperative values for all tests were collected 1–4 days before surgery. The time between end of surgery and extubation was longer in the propofol group, but early and late recovery of psychomotor function were similar in the three groups. Patients anaethetised with isoflurane reported more vegetative symptoms than those who received propofol (P<0.03). The addition of nitrous oxide to propofol did not change the reported degree of symptoms. The difference in vegetative symptoms between groups was most obvious on day 7. Patients anaesthetised with propofol reported better subjective control (P<0.02) and were more socially oriented (P<0.05) than patients anaesthetised with isoflurane. We conclude that early recovery was similar in the three groups. Patients anaesthetised with propofol reported fewer late symptoms and better mood after operation than those anaesthetised with isoflurane. The addition of nitrous oxide did not affect the result

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03799.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Propofol/alfentanil anaesthesia was compared with thiopentone/halothane anaesthesia in 86 midazolam‐atropine premedicated children undergoing minor otolaryngological surgery. The study was randomised, and evaluation of recovery from anaesthesia was double‐blind. The children were divided into two age groups: 1–3 years and 4 years and older. Particular attention was paid to EGG changes during anaesthesia and to the rapidity of recovery. One minute after alfentanil 15 μg · kg‐1, the children in the propofol group received propofol 2.0–3.0 mg · kg‐1followed by propofol infusion 15 mg · kg‐1· h‐1. In addition, 0.1% suxamethonium 6 mg · kg‐1· h‐1was infused during operation. The other children received thiopentone 5–7 mg · kg‐1followed by halothane (0.5–2%) immediately after endotracheal intubation. Junctional rhythm occurred in 5–35% of the children independent of anaesthesia method, and ventricular ectopic beats were seen in 20% of the older children during halothane anaesthesia. Recovery with respect to times to eye opening or response to verbal contact was significantly faster after propofol/alfentanil anaesthesia than after thiopentone/halothane anaesthesia in the older but not in the younger age group. Furthermore, in the younger age group significantly more crying occurred after propofol/alfentanil than after thiopentone/ halothane anaesthesia. On the basis of this study, thiopentone/halothane anaesthesia is recommended for children aged 1–3 years and propofol/alfentanil anaesthesia for older children undergoi

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03800.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Speed of recovery and length of stay in hospital were studied in 95 ambulatory patients undergoing laparoscopy or arthroscopy. The patients were divided into three groups regarding maintenance of anaesthesia. Group A (n = 32) received isoflurane 0.7% end‐tidally, group B (n = 31) propofol infusion for 25 min and thereafter isoflurane, and group C (n = 32) received an infusion of propofol throughout the procedure. Recovery was assessed by a combination of the Maddox‐Wing, the Choice Reaction Time test and p‐deletion. The awakening period was somewhat shorter in group A, but psychomotor recovery was somewhat slower compared to groups B and C. The length of stay in hospital depended on whether the patient was nauseated or not. In group A, 44% suffered from nausea requiring medical intervention compared to 13% and 19% in groups B and C, respectively. The stay in hospital was 235 ± 90 min (mean ± standard deviation) in group A compared to 184 ± 56 min and 197 ± 55 min in groups B and C, respectively. The non‐nauseated patients in group A had a stay in hospital of 188 ± 55 min compared to 184 ± 52 and 184 ± 37 in the non‐nauseated patients in groups B and C, respectively. In total, the nauseated patients (n = 24) stayed 267 ± 95 min compared to 185 ± 47 min for the non‐nauseated patients (n = 71),P<0.001. We found nausea to be the most important factor determining length of stay after ambulatory anaesthesia. Propofol in a dose higher than a normal induction dose decreases the incidence of nausea and thus the length

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03801.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The effect of diclofenac on pain after arthroscopy of the knee joint was investigated in 64 patients. The aim of this double‐blind, placebo‐controlled, randomised study was to compare administration before surgery with delayed treatment. The effect on postoperative pain was evaluated by means of a Visual Analogue Scale and recording of the need for additional analgesics postoperatively. After surgery, hourly assessments were performed within 6 h after the anaesthetic block (approximately 5 h after start of surgery), and on the morning after surgery. Both treatment with diclofenac before surgery and delayed treatment were superior to placebo concerning pain scores within 6 h after onset of anaesthesia (P<0.0065 andP<0.0005, respectively). On the morning after surgery, only delayed treatment was superior to placebo (P<0.02). No differences in pain scores were evident between the different groups treated with diclofenac. No differences in the need for additional analgesics were fo

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03802.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

In this study, we compared the central nervous system and cardiovascular system toxicity of i.v. administered 0.5% 2‐chloroprocaine (N=10) and 0.5% prilocaine (N=10) in lightly anaesthetised rats. Arterial blood pressure, ECG and EEG were continuously recorded. Prilocaine produced the predetermined toxic end‐points (i.e. seizure activity on EEG, isoelectric EEG, cardiac arrhythmia on ECG, asystole on ECG) at significantly lower doses than 2‐chloroprocaine (P<0.05). The mean dose of prilocaine producing asystole was 166 mg · kg‐1(± 45 mg · kg‐1, s.d.) vs. 255 mg · kg‐1(± 42 mg · kg‐1) for 2‐chloroprocaine (P<0.01). The rate of decrease of mean arterial blood pressure during the infusion was significantly faster with prilocaine (P<0.01). Typically, arrhythmias did not appear until just before asystole, suggesting that neither of the local anaesthetics possessed marker arrhythmogenic properties. It is concluded that prilocaine is slightly more toxic than 2‐chloroprocaine in the rat, but that both local anaesthetics have a wide margin of safety. Doses producing seizure activity on the EEG (prilocaine 53 mg · kg‐1and 2‐chloroprocaine 70 mg · kg‐1, on average) are much higher than those used in clinical

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03803.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Extracorporeal circulation with controlled hypothermic low flow perfusion was introduced during the surgical treatment of a patient with a giant intracranial aneurysm of the anterior communicating artery. Heparin‐coated equipment (Carmeda Bio‐Active Surface; CBAS) was utilized, thus reducing the need for systemic heparinization. Direct cannulation of the right atrium and aorta was established through thoracotomy. Blood flow through the circuit was kept at 4.5 1/min during normothermia. Core cooling, in combination with external surface cooling, was performed for 30 min to a temperature of 18d̀C (nasopharynx). During a period of 25 min, the time for surgical repair of the aneurysm, blood flow was minimized to 0.4 1 · min‐1, equilibrating central and peripheral blood pressures to approximately 5–10 mmHg (0.65–1.3 kPa). Reper‐fusion was started immediately after the low flow period concomitantly with rewarming, aiming at a temperature of 36d̀C following 150 min. The patient could be weaned off the extracorporeal circulation with minimal inotropic support. The postoperative course was uneventful apart from a left‐sided hemiparesis, probably due to an infarction in the area of the right pericallosal artery (A2). The patient was weaned off the ventilator after 6 days. He recovered and the hemiparesis

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03804.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The aim of the present study was to evaluate the use of the vertebral artery for cerebral blood flow studies. In eight dogs a small catheter was introduced into an unligated a. vertebralis sin. Radioactive microspheres (141Cerium) were injected and detected with a gamma camera. The microspheres were distributed to all parts of the brain. The concentrations were highest in the cerebellum, pons and medulla oblongata, while the total activity was greatest in the cerebrum because of its higher weight. The activity in the extracerebral tissues in the head was found to be less than 5% of the brain activity.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03805.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The efficacy and side effects of epidural bolus injection of 4 mg of morphine in a volume of 2 ml, 10 ml, or 20 ml (groups I, II and III) for postoperative analgesia after caesarean section (60 patients) were evaluated. All patients had epidural anaesthesia established up to T4 level with 0.5% bupivacaine 18–20 ml, supplemented with 2% lidocaine with adrenaline, when necessary. Morphine 4 mg in either of the three volumes was injected through the epidural catheter in random order after delivery of the baby. Six patients in each group reported no pain during the 24‐h follow‐up period. No additional pain medication during the 24 h after surgery was required in 11, 14 and 10 patients in groups I, II and III, respectively. Most of the others managed with the addition of a single dose of rectal ketoprofen. There were no differences in analgesic therapy between the groups. Pruritus was the most common adverse effect (18/20, 19/20 and 18/20 in groups I, II and III, respectively). 10/20, 12/20 and 14/20 (N.S.) patients had nausea and vomiting in groups I, II and III, respectively. Metoclopramide, prescribed for persistent nausea, was given to 4/20 patients in group I, 6/20 patients in group II and 9/20 patients in group III (N.S.). After removal of the urinary catheter 7/20 patient in group III required carbachol for urinary retention compared to 3/20 and 4/20 patients in groups I and II (N.S.). In this study a tenfold dilution of 4 mg of morphine did not influence the quality of analgesia after caesarean section or cause statistically significant differences in the appearance of side‐

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03806.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The effects of Ringer's acetate (RAc) infusion with different temperatures, 18d̀C compared to 36d̀C, were studied in 20 healthy volunteers. An infusion volume of 20% of the estimated extracellular volume was given over 45 min. Before and after the RAc infusion, interstitial colloid osmotic pressure and interstitial fluid hydrostatic pressure were measured on the lateral part of the thorax and in the lower leg. Blood sampling and pressure measurements were performed through a cannula placed in the left radial artery, and arterial oxygen saturation was measured by pulse oximetry. Atrial peptides ANF (99–126) and ANF (1–98) in plasma were measured as indicators of volume loading. Cold RAc infusion increased mean arterial pressure from 82 (s.d. ± 7) to 96 (s.d. ± 9) mmHg (10.9–12.8 kPa) at the end of the infusion with a simultaneous fall in heart rate. Warm RAc infusion gave no changes in blood pressure or heart rate. The arterial oxygen saturation during the infusion of cold RAc was higher than during warm RAc infusion. Cold infusion produced the expected haemodilution with a fall in erythrocyte volume fraction (EVF) from 0.39 (± 0.03) to 0.33 (± 0.03) and a fall in plasma colloid osmotic pressure (COPp) from 21.7 (± 1.1) mmHg to 15.0 (± 1.3) mmHg (2.9–2.0 kPa). Warm infusion induced a nearly identical haemodilution. Interstitial colloid osmotic pressure fell from 11.6 (± 2.3) mmHg to 8.9 (± 2.7) mmHg (1.5–1.2 kPa) after warm infusion while cold infusion gave no changes. The changes in interstitial fluid hydrostatic pressure were not significant. Cold infusion induced a higher diuresis compared to warm RAc infusion. ANF increased during cold, but not during warm infusion. We conclude that infusions of RAc at 18d̀C vs. 36d̀C have different volume effects. Cold infusion increased blood pressure and diuresis, while warm infusion induced peripheral vasodilation with increased capillary leakage and subcutan

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1993.tb03807.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY