ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03898.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Thirty patients who underwent coronary artery bypass grafting were randomized to receive 30% oxygen by mask either with an ambient airway pressure or with 7.4 mmHg (1 kPa) continuous positive airway pressure (CPAP) for 8 h after extubation. Arterial blood oxygen tension (Pao2) decreased remarkably in the control group after extubation (from 19.2± 5.3 kPa to 12.4 ± 2.7 kPa) but less in the CPAP group (from 16.4 ± 3.3 kPa to 14.0 ± 2.1 kPa). On the second postoperative morning Pao2was equally low in both groups (control: 8.4 ± 1.5 kPa, CPAP: 8.9 ± 1.9 kPa). Atelectatic areas were seen with similar frequency in both groups, 17% (whole material) on the first and 50% on the second postoperative morning. Atelectasis was more common in patients with internal thoracic artery grafting and/or pleural drainage. In conclusion, CPAP therapy was well tolerated, and minimized the decrease in Pao2after extubation, but could not prevent the poor oxygenation or the late development of atelectatic areas on the second postoperativ

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03899.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The analgetic effect of bupivacaine given epidurally or interpleurally after thoracotomy was investigated in a randomized, double blind, placebo controlled study. 32 patients with both an epidural and an interpleural catheter, were randomized to receive either interpleural or epidural analgesia. The interpleural group was given bupivacaine 5 mg ml‐1with 5 microgram epinephrine as a 30 ml interpleural bolus, followed by a continuous infusion starting at a rate of 7 ml per hour and epidurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The epidural group was given bupivacaine 3.75 mg–ml‐1with 5 microgram epinephrine as a 5 ml epidural bolus, followed by a continuous infusion starting at a rate of 5 ml per hour and interpleurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The draining tubes were clamped during the injection of the interpleural bolus and 15 min afterwards. Adequacy of pain relief was evaluated with the Prins–Henry pain scale. Morphine requirement was registered, there was no difference between the groups in painscores or need for additional m

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03900.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Ropivacaine, a new long–acting amino–amide local anaesthetic agent, and bupivacaine, in various concentrations with or without addition of adrenaline, were tested in a randomized, double–blind study using intradermal wheals. Ten non–smoking, healthy, young male volunteers participated. Inseries Iplain solutions of ropivacaine (0.25%, 0.5%, 0.75% and 1%) and bupivacaine (0.25%, 0.5% and 0.75%) were injected intradermally and inseries IIthe same concentrations, with the addition of adrenaline 5 ug ml‐1(1:200 000), were used. The same volunteers took part in both series, with an interval of at least three weeks between the experiments. Saline was included as control in both series. Pin–pricking was used to assess the dermal analgesia. Plain solutions of ropivacaine produced significantly longer durations of dermal analgesia than did plain solutions of bupivacaine, in all tested concentrations. A significant increase in duration was seen for both local anaesthetics when adding adrenaline. Local vascular effects at the injected areas were determined by visual inspection (nil, pink, pale). Local blanching (pale) was significantly more frequent for plain solutions of ropivacaine, in all tested concentrations. Local redness (pink) was significantly more frequent with plain bupivacaine, in a dose–dependent relation. An initial redness was frequently observed for both local anaesthetics containing adrenaline, followed by blanching

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03901.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Forty–two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid and acetaminophen regimen. Patients undergoing knee– or hip arthroplasty treated with epidural analgesia had significantly lower pain scores during mobilizationunderthe 48 h epidural infusion compared with patients receiving conventional treatment, while no important differences were observedaftercessation of the epidural regimen. However, the achieved pain relief had no impact on postoperative convalescence parameters, such as ambulation, patient activity including need for nursing care, fatigue or hospital stay. Late postoperative pain, fatigue and conservative attitudes and routines in the postoperative care, were the most important reasons limiting mobilization and activity. We conclude that effective early (48 h) postoperative pain relief with balanced analgesia does notper selead to important improvements in convalescence and hospital s

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03902.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A prospective, randomized, controlled study was performed to determine the haematological and biochemical changes and clinical safety of postoperative autotransfusion (Solcotrans Orthopedic Plus® system) in patients undergoing spinal surgery. Fifty patients were studied and were randomly allocated to Control (n = 25) and Solcotrans (n = 25) groups. Both groups had their postoperatively drained blood collected into the Solcotrans reservoir but only the Solcotrans group had this salvaged blood considered for reinfusion. After a 5–h postoperative collection period, analysis of the shed blood showed a haematocrit of 0.26± 0.11, few platelets (80 ± 63 10g1‐1), a fibronogen level of less than 0.1 gl‐1and a high level of D‐dimers. The salvaged blood did not clot and aerobic and anaerobic culture produced no growth. The volume of blood collected was greater than 200 ml in 21 patients in the Solcotrans group who were autotransfused (384 ± 101 ml, range 200–600 ml), and in 16 patients in the Control group. Within 15 min following completion of reinfusion of the salvaged blood there was a significant, but moderate decrease in platelet count (181 ± 74 vs 223 ± 90 108 1‐1,P<0.001) and fibrinogen concentrations (2.1 ± 0.8 vs 2.3 ± 0.9 g 1‐1,P<0.02), and an increase in circulating D–dimers (P<0.001) and plasma free haemoglobin concentrations (236 ± 155 vs 82 ± 79 mg l‐1,P<0.001). Prothrombin time (PT) and activated partial thromboplastin time (APTT) did not increase, and potassium concentrations were not significantly affected. Because the haematocrit of shed blood was lower than that in the patients' systemic blood, there was no significant increase in haematocrit following reinfusion. Cultures of systemic blood following reinfusion yielded no bacterial growth. No side–effects were observed. There were no significant differences in the haematological parameters (haematocrit, platelet count, free haemoglobin, APTT, PT, fibrinogen, D–dimers) between the two groups at the eighth (3 h after reinfusion) and the 24th postoperative h. No predictive factor of the volume of blood collected during the postoperative period could be identified. Postoperative autotransfusion induced no clinically relevant haematological effects after spinal surgery. However, since important haematological modification were found in the shed blood, further studies are required to determine the maximum amount of shed blood that can be safely transfused

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03903.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The effectiveness of an anaesthetic technique employing diclofenac sodium as an analgesic given preoperativey by intramuscular injection was compared against one employing intravenous fentanyl in patients undergoing laparoscopic sterilization. Postoperative pain was marked and both drugs provided partial relief only. Patients in the diclofenac group had pain scores that were initially higher than those in the fentanyl group and the difference between the groups was statistically significant (P<0.02). Patients in the diclofenac group who received postoperative supplemental morphine analgesia recorded lower pain scores at 30 min than comparable patients in the fentanyl group (P<0.03). These findings suggest that neither drug provides sufficient analgesia for laparoscopic sterilization when given as a sole analgesic. Investigation of a combined analgesic technique employing morphine and a non–steroidal anti–inflammatory drug is warran

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03904.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Continuous thoracic paravertebral blockade (PVB) has only recently been reported in pediatric patients. The aim of the present study was to compare retrospectively the postoperative analgesic efficacy of PVB vs conventional lumbar epidural blockade (EDA) in children. Thirty–five consecutive pediatric patients undergoing renal surgery, receiving either PVB (n = 15) or EDA (n = 20), were reviewed. The need for supplemental morphine administration during the first 24 postoperative hours was used to assess the postoperative analgesic efficacy of the two different regional techniques. Both the total amount of supplemental morphine and the number of patients with no need for supplemental morphine administration, were compared between the two groups. The need for supplemental morphine administration was significantly lower (P= 0.046) and the number of patients with no need for supplemental morphine administration postoperatively was significantly higher (P= 0.019) in patients treated with PVB vs EDA. The present study indicates that PVB may possess a potential for postoperative analgesia equal to or maybe even superior to conventional lumbar EDA in pediatric patients undergoing renal surgery. Further prospective studies investigating the analgesic efficacy of this novel technique are warrante

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03905.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Resedation after antagonism of midazolam sedation with flumazenil may occur because some individuals have rapid elimination of flumazenil but slow elimination of midazolam. To determine whether there are parallel or divergent rates of elimination of the two drugs between individuals, the pharmacokinetic profiles of midazolam and flumazenil were studied simultaneously in 12 adult male volunteers. Free drug concentration data for the two drugs were incorporated into a receptor occupancy model and psychomotor testing was performed and correlated with receptor occupancy. Variation was found between individuals in the pharmacokinetics of the two drugs. There were significant correlations between Cltot, (P<0.01) but not in t1/2a, t1/2b, Vc, or VDst. In individuals, midazolam elimination half–life ranged from less than half that of flumazenil to more than three times that of flumazenil. There was a relatively poor, although statistically significant linear correlation found between calculated receptor occupancy and critical flicker fusion frequency, r = 0.50,P<0.01, and linear analogue scales of sedation r = 0.56,P<0.005; and anxiolysis, r = 0.54,P<0.005. There is divergence in the disposition and elimination of midazolam and flumazenil in some individuals. A benzodiazepine receptor occupancy model is useful for predicting the consequent differences in clinical effect when the drugs are given togethe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03906.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The differences in effects of anaesthetic agents on right ventricular function have not been studied. We have developed a cross–over study design to compare the effects of propofol and isoflurane on cardiac and specifically right ventricular function. Ten patients were anaesthetised with equivalent MAC of isoflurane to MIR of propofol. After measurements had been taken on the randomly assigned first agent the patients were crossed over to the other agent and measurements were repeated. Cardiac function was assessed using a pulmonary artery catheter with a fast response thermistor. There were no differences in heart rate or blood pressure between the two agents suggesting that equivalent anaesthetic doses had been given. There were significantly (P<0.05) higher cardiac output (4.0 to 4.5 1 min‐1), right ventricular ejection fraction (35.1 to 39.4%), stroke volume (35.4 to 39.6 ml) and right ventricular end–diastolic volume index (102 to 110 ml m2–1) with propofol compared to isoflurane. We conclude that propofol results in improved right ventricular performance compared to isoflurane. We have also shown that anaesthetic agents can be compared using a cross–over study design, and have demonstrated that MAC of isoflurane and MIR of propofol can be directly compared. We suggest that propofol may be a more suitable agent than isoflurane for anaesthesia in patients who may already have impaired right ventricular function and in whom maintaining high cardiac output may be b

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03907.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY