摘要:

A controlled investigation was conducted to compare the efficacy of ketoprofen and pethidine in relief of postoperative pain after nasal surgery. Sixty patients were randomly allocated to receive intravenous ketoprofen 1.5 mg · ml‐1or pethidine 1 mg · kg‐1during induction of anaesthesia. Appearance, pain and headache were assessed 1, 2, and 4 h postoperatively, and the following morning. The use of ketoprofen was associated with a significantly faster recovery from anaesthesia (P<0.001), and a more rapid return to calm awakening (P<0.05). Patients who received ketoprofen had significantly lower pain and headache scores (P<0.01 andP<0.001, respectively), and required significantly (P<0.05) less postoperative analgesia. No significant difference in incidence and severity of postoperative nausea or vomiting was found between the two groups at any time. A single intravenous dose of ketoprofen during anaesthesia may offer an advantage compared to pethidine in reducing postoperative pain following nasal su

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03289.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The effects of three different doses (0.5, 1.0 and 1.5 μg/kg) of dexmedetomidine, a novel α2‐adrenoceptor agonist, on vigilance, anaesthetic requirements, haemodynamics, and plasma catecholamine levels were investigated in a double‐blind placebo‐controlled study in 20 healthy (ASA physical status I‐II) women scheduled for uterine dilatation and curettage (UD&C). The drug was administered intramuscularly 60 min before induction of anaesthesia with thiopentone. N2O/O2(70/30%) and thiopentone was used for maintenance. There were no significant differences between the groups in thiopentone requirements, plasma adrenaline concentrations, or subjective or objective assessment of sedation before anaesthesia and UD&C. Blood pressure, heart rate, and plasma noradrenaline levels were reduced after dexmedetomidine, with three patients receiving atropine for excessive bradycardia (less than 45 beats min‐1). The haemodynamic as well as the sedative effects of dexmedetomidine after surgery lasted until the end of the observation period, 4 h after the injection of the drug, indicating that intramuscular administration of this premedication agent may result in a longer than optimal duration of pharmacological actions in connection with short surgical

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03290.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The influence of different oxygen flow rates on ventilation and arterial blood gases was investigated in ten healthy volunteers during oxygen treatment with the Hudson® mask. Respiratory parameters were calculated using inductive plethysmography calibrated against pneumotachography. The minute ventilation was greater when using the mask with oxygen flow rates less than 5 1/min compared to when no mask was used. With an oxygen flow rate of 3 1/min, minute ventilation was about 140% of minute ventilation without face mask. With 0 1/min, minute ventilation increased to about 160%. The increase in minute ventilation was mainly due to an increase in tidal volume. No change was seen, however, in Paco2with different oxygen flow rates. Secondary objective signs following an increase in respiratory work (changes in heart rate, systolic blood pressure and oxygen saturation) were not seen. We recommend 5 1/min as the lowest oxygen flow rate to be used during oxygen therapy with the Hudson mask, in order to avoid rebreathing and excessive respiratory work

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03291.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The effect of controlled, experimental ischaemic pain, induced by tourniquet, on gastric emptying of a semi‐solid meal of Tc‐99m labelled Chelex‐100 resin/oatmeal was assessed in seven healthy volunteers, each acting as his/her own control. In the pain study, the submaximal effort tourniquet test was applied immediately, 30 min and 45 min after beginning of the study. Pain intensity was rated during the procedure using a linear visual analogue scale (VAS). All subjects participating in the study assessed their pain as close to maximal tolerance after 2–4 min. The pain stimulus caused an immediate acceleration, followed by a reproducible, significant delay in gastric emptying relative to the control situation. The median reduction in meal emptied after 60 min in the pain study was 15% (P=0.035). There was no difference in the duration of the lag period between the

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03292.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The importance to mucociliary transport (MCT) and the condition of the mucus of using a heat and moisture exchanger (HME) was investigated. A high tracheotomy was performed on 10 young pigs. The animals were ventilated using a non‐breathing system. In five animals an HME was used; the other five were connected directly to the ventilator circuit. After 6 h the trachea was inspected via a flexible bronchoscope. Mucociliary transport velocity was measured using Tc‐99‐marked macrospheres and a gamma camera. In the control group the tracheal mucus membrane was desiccated at half the distance from the tube tip to the bifurcation. In the HME group the entire trachea was well moistened, but two cases showed large amounts of abnormally thin and foamy secretion. Mucus quality differed significantly between the two groups. Maximum MCT velocities were 8.3 ± 4.6 and 4.9 ± 3.0 mm/min for the HME‐ and the control groups, respectively. The marker had moved 49 ± 32 and 35 ± 21 mm during 24 min. Neither of these differences was statistically significant. In the control group there was no transport over desiccated areas. We conclude: 1) the quality of tracheal secretion differed significantly between the two groups, and 2) a heat and moisture exchanger may retain too much water in

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03293.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Plasma levels of vitamin E (Vit. E), total lipids (TL), Vit. E to TL ratio and myeloperoxidase (MPO) were studied in 20 patients undergoing lumbar spinal surgery and randomly allocated to two anesthetic groups: propofol (bolus dose + continuous infusion) and thiopental/isoflurane. Peripheral blood samples were withdrawn prior to induction, each hour during anesthesia and 1 h after the end of surgery. Mean Vit. E and TL levels as well as mean Vit. E to TL ratios remained in the normal range over the entire period of study whatever the anesthetic regimen. MPO levels rose significantly in the post‐operative period only, but without statistical difference between the two groups. Therefore, anesthesia with propofol or thiopental/isoflurane modifies neither total lipid concentrations nor plasma Vit. E, which is a potent endogenous inhibitor of lipid peroxidation bound to lipoproteins. The rise of plasma MPO suggests a moderate post‐operative neutrophil activation which is not influenced by anesthetic techniq

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03294.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The functional tip tapering design of peripheral venous cannulae (introducer steel needle + catheter) made of polyurethane (PUR‐Insyte®) and polytetrafluoroethylene (PTFE‐Venflon®) was studied with 3 techniques: A) Scanning electron microscopy (SEM). B) Measurement of penetration forces invitrothrough latex membranes and lamb skins with a tensile‐compression apparatus (Instron‐1122®) at 1) the introducer steel‐needle point, 2) the needle heel (the spot marking the passage from the point of the needle to its shaft), 3) the catheter top (i.e. the beginning of the plastic sheath), 4) the catheter tip, i.e. the beginning of the largest diameter of the plastic sheath, and 5) between the catheter tip and its hub (catheter friction). C) Two cannulae (one of each type for every subject) were inserted at random into the dorsal veins of the left and right hand in 37 volunteers, and the penetration forces were measured with a force transducer. Results: A) The PUR‐cannulae had a lancet‐like appearance and a smoother transition at the catheter top, whilst the PTFE cannulae were arrow‐like, cut back and had a less accentuated conical design. B) Penetration forcesin vitrothrough latex membranes were 9–41 times lower (P<0.0001) than those through the lamb skins. The highest forces (mean · s.d.) registeredin vitro(lamb skins) were 4.1 ± 0.2 Newtons (N) with PUR‐cannulae at the catheter tip, and 3.4 ± 0.6 with the PTFE‐cannulae at the catheter top (P<0.05). C).In in vivo(volunteers), significantly (P<0.001) higher forces were required with the PUR‐cannulae than with the PTFE‐cannulae for penetration of both the skin (3.9 ± 1.6 vs 2.7 ± 0.8 N) and the vein wall with continued penetration of the skin (3.5 ± 1.2 vs 2.4 ± 0.9 N). When the highest penetration forces were compared, no significant differences betweenin vitro(lamb skins) andin vivo(skin and vein with continued skin penetration) studies were found with either of the two cannulae studied. We conclude that there were statistically significant differences between penetration forces of the PUR and PTFE‐cannulae when inserted into the dorsal veins of the hand. Penetration forcesin vitro(lamb skins) may predict with acceptable accuracy the penetration fo

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03295.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

During a 26‐month period, 158 central venous catheters were inserted in 114 children (median age: 4.5 years) with malignant diseases. Polyurethane catheters were used, inserted either using a cut‐down procedure or percutaneously in the external or internal jugular vein. All catheters were tunnelled from the point of insertion to the midpoint of the manubrium or upper sternum. The catheter tip reached the superior caval vein or the right atrium in 94% of the cases. The catheters were used for all infusions, including total parenteral nutrition, and for blood sampling. The median catheter duration was 104 days (range 5–835 days). Sixty‐eight (43%) of the catheters were removed as they were no longer needed, and 31 (20%) were removed due to local infection or septicaemia. During a total of 23486 catheter days (64.4 years), 110 episodes of septicaemia occurred. This represents one episode per 214 catheter days. In 43 of the 110 episodes of septicaemia, blood cultures showed growth of bacteria of the kind usually found in the gastrointestinal and respiratory tracts. All septicaemias were treated with intravenous broad‐spectrum antibiotics and in 21 cases the catheters were removed due to septicaemia. Thirty‐four (22%) catheters were removed accidentally. There were two cases of subclavian vein

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03296.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The effects of caffeine, halothane, succinylcholine, phenylephrine and isoproterenol on force of contraction were studied in electrically driven (0.2 Hz) trabeculae isolated from the right ventricles of the hearts of malignant hyperthermia susceptible (MHS) and healthy control (nMHS) swine. Caffeine (0.1–10 mmol/l) had positive inotropic effects, amounting to 275 ± 35% of control in nMHS and 268 ± 34% in MHS (n = 16). Halothane (0.25–4 vol%) decreased the force of contraction maximally to 52 ± 4% in nMHS and 51 ± 5% of control in MHS (n = 16). Propranolol did not change these effects. Succinylcholine (0.1–1000 μmol/l) had a small positive inotropic effect in both groups, which was blocked by propranolol. Phenylephrine (0.1–300 μmol/l) increased the force of contraction maximally to 188 ± 24% of control in nMHS and to 193 ± 23% in MHS (n = 16). The inotropic effect was blocked by prazosin but not by succinylcholine (1 mmol/l). Isoproterenol (0.01–10 μmol/l) had a positive inotropic effect of maximally 275 ± 21% of control in nMHS and 396 ± 31% in MHS (n = 17) (P<0.05). Succinylcholine potentiated this effect, and propranolol shifted the concentration‐response curves to the right. We conclude that caffeine, halothane, succinylcholine and phenylephrine have similar inotropic effects in the hearts of nMHS and MHS, whereas isoproterenol has a significantly greater effe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03297.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This study was designed to compare the ease of performing laryngoscopy and endotracheal intubation without muscle relaxants after the induction of anaesthesia with either thiopentone or propofol in 106 patients scheduled for elective surgery. Thiopentone (5 mg/kg) or propofol (2.5 mg/kg), supplemented with lidocaine (1.5 mg/kg) and alfentanil (30 μg/kg), were used in random order for the induction of anaesthesia. Jaw tone, visualisation of the larynx, position of vocal cords, ease of intubation and tolerance of the tracheal tube were assessed. The jaw was relaxed and the vocal cords were immobile/open in most patients in both groups. Visualisation of the larynx was good in 60 and 46%, and intubation was easy in 48 and 22% of the patients given thiopentone and propofol, respectively (P<0.05 between groups for intubation). After induction of anaesthesia with thiopentone or propofol, endotracheal intubation is not recommended without the use of muscle relaxants

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03298.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY