ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This study compared the effect of two anaesthetic techniques on the catecholamine levels in children undergoing ilioinguinal herniorrhaphy. Forty male paediatric patients ASA class I were allocated randomly to one of two groups: the control group (n=20) received general anaesthesia including intravenous fentanyl; and the caudal group (n=20) received caudal anaesthesia with bupivacaine 0.25% 1 mL kg−1combined with general anaesthesia but without opioids. Plasma adrenaline and noradrenaline concentrations were measured at induction, at the end of surgery and in the post-anaesthesia care unit (PACU). In the caudal group, there were significant decreases in the adrenaline and noradrenaline concentrations at the end of surgery and in the PACU compared with baseline concentrations. In the control group, there was a significant increase in PACU concentrations of adrenaline and noradrenaline compared with baseline concentrations. These findings suggest that the addition of a caudal block to general anaesthesia in children undergoing ilioinguinal herniorrhaphy decreases significantly the neurohormonal responses to surgery.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In order to elucidate temporal changes in airway reflex responses to prolonged tracheal intubation, 14 patients anaesthetized with sevoflurane were studied. In each spontaneously breathing patient with an endotracheal tube in place, the end-tidal concentration of sevoflurane was slowly decreased from the initial value of 1.3% until signs of airway irritation were observed. The value of end-tidal sevoflurane concentration at which the airway reflexes occurred (Tar) and the types of airway reflex response elicited at onset of airway reflex response were determined during the periods immediately before (presurgical period) and after surgery (post-surgical period), with an interval ranging from 2 to 7 h between the two periods. There was no significant difference in the values ofTarbetween the presurgical period (0.6±0.3%, mean±SD) and the post-surgical period (0.7±0.1%). There was a considerable difference in the type of airway reflexes elicited during the two different periods; the initial responses during the presurgical period were the apnoeic reflex and/or forceful expiratory efforts, whereas the initial response during the post-surgical period, in the majority of patients, was the swallowing reflex. Our results indicate that there may be adaptation mechanisms responsible for temporal changes in airway protective reflexes after prolonged endotracheal intubation in surgical patients.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The study compares responders and non-responders to post-operative patient-controlled analgesia (PCA) and evaluates factors that might differ between these two groups in order to identify non-responders during the early post-operative period. A prospective, randomized, double-blinded study design was used. Patients recovering from abdominal surgery were assigned to one of three treatment groups for a study period of 48 h. After titration of an individual loading dose, patients could self-administer 1 mL bolus doses (2 mg of morphine, 20 mg of tramadol or placebo) using a PCA device. Patients responding or not responding to the treatment were identified. In non-responders the escape medication was morphine. There were 96 responders and 65 non-responders. All responders showed similar pain scores, irrespective of the drug they received. Drug consumption of placebo responders was twice as high as that of opioid responders. Pain scores and analgesic consumption of non-responders were significantly higher compared with responders, although those patients received morphine. The loading dose correlated with subsequent analgesic consumption. Altogether, 89.2% of the non-responders were identified after the loading dose. Size of loading dose and pain scores during the first 30 min are useful for assessing the overall response to post-operative pain management. These factors may be valuable for predicting individual pain management.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The effects of controlled hypotension induced with trimethaphan (TMP), nitroglycerin (TNG) or prostaglandin E1(PGE1) during sevoflurane anaesthesia on hepatic function were studied in 28 patients under-going spinal fusion surgery. Patients were randomly divided into three groups to receive TMP (group A,n= 10), TNG (group B,n= 10) or PGE1(group C,n= 8). Anaesthesia was maintained with N2O and sevoflurane. The mean arterial blood pressure was maintained at 60 mmHg for 90 min. Measurements included arterial ketone body ratio (AKBR-acetoacetate/3-hydroxybutyrate), SGOT, SGPT, LDH, blood glucose and blood gases were made. Measurements were taken before hypotension, 60 min and 90 min after starting hypotension, 60 min after recovery from hypotension and on the post-operative day. AKBR showed no significant change. SGOT, SGPT and LDH were within normal limits. Controlled hypotension induced with TMP, TNG or PGE1under sevoflurane anaesthesia in surgical patients did not cause hepatocellular damage.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Two daily doses of oralHarpagophytumextract WS 1531 (600 and 1200, respectively, containing 50 and 100 mg of the marker harpagoside) were compared with placebo over 4 weeks in a randomized, double-blind study in 197 patients with chronic susceptibility to back pain and current exacerbations that were producing pain worse than 5 on a 0-10 visual analogue scale. The principal outcome measure, based on pilot studies, was the number of patients who were pain free without the permitted rescue medication (tramadol) for 5 days out of the last week. The treatment and placebo groups were well matched in physical characteristics, in the severity of pain, duration, nature and accompaniments of their pain, the Arhus low back pain index and in laboratory indices of organ system function. A total of 183 patients completed the study. The numbers of pain-free patients were three, six and 10 in the placebo group (P), theHarpagophytum600 group (H600) and theHarpagophytum1200 group (H1200) respectively (P=0.027, one-tailed Cochrane-Armitage test). The majority of responders' were patients who had suffered less than 42 days of pain, and subgroup analyses suggested that the effect was confined to patients with more severe and radiating pain accompanied by neurological deficit. However, subsidiary analyses, concentrating on the current pain component of the Arhus index, painted a slightly different picture, with the benefits seeming, if anything, to be greatest in the H600group and in patients without more severe pain, radiation or neurological deficit. Patients with more pain tended to use more tramadol, but even severe and unbearable pain would not guarantee that tramadol would be used at all, and certainly not to the maximum permitted dose. There was no evidence forHarpagophytum-related side-effects, except possibly for mild and infrequent gastrointestinal symptoms.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 42-year-old man presented as an emergency to the ENT department with sore throat and complete dysphagia, having undergone an umbilical hernia repair under general anaesthesia with tracheal intubation 3 weeks previously at another institution. One course of antibiotics from his general practitioner improved the symptoms but, on discontinuation of the antibiotics, symptoms flared up leading to complete dysphagia. Indirect laryngoscopy showed a bulging of the retropharyngeal wall, which was confirmed as a widening of the retropharyngeal space on a lateral soft-tissue X-ray film of the neck. Surgical exploration confirmed a retropharyngeal abscess, which probably occurred as a complication of the original tracheal intubation.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID