ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03528.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This article reviews the problem of bleeding in connection with epidural/spinal anaesthesia, with special emphasis on the use of low molecular weight heparins for thromboprophylaxis. There are methodological difficulties to studying the problem in a scientifically correct way because of the rarity of the complication. However, from the data in the literature there are no indications of an increased risk in using the combination of low molecular weight heparin in prophylactic doses and epidural/spinal anaesthesia. So far, there is only a single case report, of spinal haematoma, although low molecular weight heparins have been used in combination with epidural/spinal anaesthesia in at least 1000000 patients. In controlled studies, at least 10000 patients have been given the combination without complications.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03529.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A new system, Nursing Care Recording (NCR), for the recording of nursing care in a general ICU is presented. NCR classifies ICU patients according to their need for intensive nursing care. Comparing the NCR with the Therapeutic Intervention Scoring System (TISS), a correlation coefficient of 0.60 was found. The main difference between the two systems was related to recording procedures allowing changes in nursing intensity within a 24‐h period, reflecting patient improvement due to therapy, which was detected by NCR but not by TISS. NCR can be used to estimate nursing capacity during different shifts and may be useful in the assessment of the total nursing staff necessary for a given ICU. It is suggested that NCR will allow detection of changes in the nursing care work load, whether this change is due to new activities in the unit or to alterations in the individual patient car

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03530.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Standardized behavioural observations were used to establish the influence of the type of anaesthesia on the mental function and the subjective physical well‐being in 60 patients, all men, following urological surgery. The patients were randomized to two groups, receiving spinal or general anaesthesia. For evaluation of the influence of pre‐operative physical condition on post‐operative mental function, a supplementary group of 34 patients with pre‐existing cardiovascular and/or pulmonary disorders was included in the study. These patients all received spinal anaesthesia. The patients were observed from the day before surgery until 4 weeks after. In all patients a short‐lasting temporary decline in mental function was observed. The outcome was not influenced by the type of anaesthesia. In the two groups receiving spinal anaesthesia the decline in post‐operative mental function and subjective sense of well‐being was most pronounced in patients with a compromised physical condition pre‐operatively. Four weeks after surgery, no signs of mental deterioration were present; however, the subjective sense of physical well‐being had n

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03531.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The amounts of halothane and isoflurane trapped after exposure for up to 3 h at 2 MAC in commonly used anaesthesia circuit tubing were quantitated by gas chromatography. The decontaminating effects of procedures such as flushing with oxygen, thermal disinfection and/or routine storage were assessed in a similar way. After halothane exposure, anaesthetic content was highest in silicone (398 ± 55 mg 100 g‐1). Lower quantities were found in all other tubings investigated (electrically conductive latex: 64 ± 4, conductive rubber: 62 ± 4, polyethylene‐vinyl‐acetate (PEVA): 293 ± 10 and 149 ± 17 for non‐conductive corrugated and spiral tubes, respectively, polysulfone (Hytrel®): 155 ± 10 mg 100 g‐1). The isoflurane contents were substantially lower (silicone: 278 ± 23; others: 55 ± 7, 61 ± 6, 163 ± 9 and 86 ± 8, 74 ± 4 mg 100 g‐1). The tubings' content did not correlate with the material's partition coefficient as full saturation was not achieved during exposure. Decontamination procedures reduced the content of volatile anaesthetics to a variable extent. Conductive latex and rubber showed the highest residual content, even after thermal disinfection and subsequent storage. Twenty‐minute flushing with oxygen (8 1 min‐1) decreased effluent gas concentrations below 5 p.p.m. in all tubings. With silicone, after 1 h flushing, halothane concentrations still exceeded 10 p.p.m. (isoflurane: 8 p.p.m.). It is concluded that urgent decontamination by a 20‐min flush warrants the safe re‐use of previously ‘contaminated’ conductive rubber and latex as well as polysulfone tubings in critical situations, e.g. in malignant hyperthermia patients if disposable tubing is not immediately available. In contrast, we warn against re‐using silicone and disposable PEVA tubing because of high uptake and

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03532.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The effects of progressive, isovolemic hemodilution using Dextran 70 and the effect of halothane (0.7, 0.9, 1.1, and 1.3% end‐tidal, administered randomly at each level of hemodilution) on global cardiovascular and regional LV contractile functions were investigated in 24 dogs with induced critical constriction of the left anterior descending coronary artery (LAD). Two additional groups of six dogs each (with and without LAD stenosis) not undergoing hemodilution served as time controls. Regional LV contractile function was assessed by sonomicrometry in the flow‐compromised apical LAD territory, as well as in three non‐compromised LV areas supplied by the left circumflex coronary artery. Regional myocardial function was found to be stable throughout the study period of 4–5 h in both time control groups. Mean arterial and coronary perfusion pressures as well as LV dP/dtmin decreased (P<0.01) during hemodilution. LV dP/dtmax remained unchanged, and heart rate and LVEDP increased slightly (P<0.05). Systolic shortening (SS) in the LAD territory was unchanged at a hematocrit (HCT) of 33.5 ± 0.3% (mean ± s.e. mean), and decreased marginally at an HCT of 24.2 ± 0.1% (SS of 17.4 ± 1.0% as compared to 20.2 ± 1.6% at critical constriction (CC),P<0.05). No increase in post‐systolic shortening (PSS) occurred in the compromised area. Severe LAD dysfunction was observed in the LAD territory at an HCT of 14.9 ± 0.1%, as systolic shortening decreased (11.8 ± 1.1%,P<0.01 vs CC) and PSS increased (31.2 ± 3.4%,P<0.01 vs CC). The effects of hemodilution on global cardiovascular and regional myocardial functions were unaffected by halothane. Mild and moderate hemodilution therefore are relatively well tolerated in LV areas supplied by a compromised coronary artery, and the critical level of isovolemic hemodilution is between a hematocrit of 1

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03533.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This study investigated the pain‐relieving effect of an intensive type of periosteal acupuncture stimulation in patients with idiopathic pain disorder. Twelve patients, 2 males and 10 females, with a mean age of 54, were included in the study. The average duration of their pain was 12.6 years. Each treatment consisted of brief but painful manual stimulation of 3 to 4 periosteal sites. Over a 3–8‐month period each patient had between 4–11 treatments, an average of 7. Analgesic drugs that patients were on prior to the study were continued but no other physical or psychological treatment for their pain was applied. Ten patients had either no responses to treatment or only transient responses which were not maintained until the following treatment. Two patients benefitted from treatment, having long periods of substantial pain reduction. All responses were assessed on pain scales maintained daily before and during the entire period of treatments. For the majority (83%) of patients in this study, with an idiopathic pain disorder, periosteal acupuncture stimulation was not a treatment alte

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03534.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The purpose of the study was to evaluate three different doses of intra‐articular bupivacaine plus adrenaline in relation to per‐ and postoperative pain relief following arthroscopy. Sixty patients were allocated to three groups of 20 patients each scheduled for arthroscopy. They were randomized prospectively to receive bupivacaine plus adrenaline 25 mg + 50 μg, 50 mg + 100 μg, 75 mg + 150 μg, respectively, diluted to a volume of 30 ml. Four patients were excluded because the operation could not be carried out under intraarticular analgesia, 18 patients had a diagnostic arthroscopy and 38 patients had different arthroscopic operations performed. The number of patients scoring pain in the knee as moderate or severe was less in Group 3 than in the other two groups, i.e. the highest dose had a better pain relief. No adverse effects were registered. With respect to per‐ or postoperative administration of analgesics, postoperative pain occurrence, and the surgeon's acceptance of the method, there were no statistically significant differences. Ninety‐two percent of the patients would prefer intraarticular analgesia if they should need to have another arthroscopy

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03535.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Twenty‐eight patients scheduled for lung resection with lateral thoracotomy and postoperative chest drains during combined thoracic epidural bupivacaine plus morphine and general anaesthesia were studied. Post‐operative pain treatment was continuous epidural infusion of bupivacaine 0.25% 5 ml h‐1plus morphine 0.2 mg h‐1for 48 h and, in addition, the patients received rectal piroxicam 40 mg randomly and double‐blind 12 h and 1 h before surgery and 20 mg 24 h‐1postoperatively or placebo. Pain was evaluated at rest, during cough and mobilisation, together with pulmonary function (FEV1, FVC, PEFR) and sensory level of analgesia repeatedly for 48 h. The results showed efficient pain relief, but without differences in pain scores or need for supplementary analgesics between the two groups. Pulmonary function decreased similarly in the two groups. Thus we were unable to show enhanced analgesia by supplementing an otherwise effective low‐dose epidural bupivacaine and morphine treatment with piroxicam after thoracic surgery with

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03536.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Nebulized beclomethasone dipropionate was administered to 14 anesthetized and artificially ventilated pigs at 6‐hourly intervals after infusion of liveS. aureus(BDP group). Changes in pulmonary activity from autologous granulocytes labeled with In‐111 was detected externally for 12 (n = 8) to 44 h (n = 6). The changes were compared with those in ten pigs (12 h n = 7, 44 h n = 3) subjected to the same insults but given no corticosteroid (placebo group). Serial measurements of blood radioactivity, and cardiac output were performed in animals observed for 12 h. Corticosteroid‐treated pigs showed a gradual decline in decaycorrected pulmonary In‐111 activity. The placebo group displayed a more varied reaction, but most animals had an increased activity compared to the corticosteroid group. The difference between the groups was significant at 8 h (BDP‐group 92% (88–98), placebo‐group 107% (97–121), median (lower‐upper quartiles), baseline = 100%.P<0.01, U‐test). Blood radioactivity and cardiac output did not differ significantly between the two groups. Nebulized corticosteroid thus diminished pulmonary granulocyte accumulation, which may be of value in the treatment of septic r

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1992.tb03537.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY