ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Replacement of the aortic valve exposes the left ventricle to myocardial ischaemia and imposes on it abrupt changes in loading conditions and geometry. We studied the immediate changes in the left ventricular function of patients undergoing aortic valve replacement by transoesophageal echocardiography. Patients with aortic regurgitation responded to surgery with a decrease in global systolic function associated with a fall in preload. Patients with aortic stenosis showed an impairment in myocardial contractility and ventricular filling, and their global systolic function did not improve despite the marked reduction in afterload. This can be a consequence of inadequate myocardial protection and intra-operative ischaemic injury of the hypertrophic myocardium. Information provided by transoesophageal echocardiography contributes to optimal and individualized management of the period immediately after aortic valve replacement.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Nausea and vomiting are common side effects of opioids administered for pain control. This double-blind, randomized, parallel-group study evaluated the anti-emetic efficacy and tolerability of single intravenous (i.v.) doses of ondansetron 8 mg, ondansetron 16 mg and metoclopramide 10 mg in the treatment of opioid-induced emesis. Adult patients undergoing low emetogenic surgical procedures, using a standardized anaesthesia regimen were assessed for 24 h following administration of study anti-emetic to treat established post-surgical opioid-induced emesis. A total of 4511 patients were enrolled of whom 1366 experienced opioid-induced emesis and received randomized study medication. Ondansetron 8 mg and 16 mg were significantly better than metoclopramide 10 mg (P<0.05) for both complete control of emesis, complete control of nausea and other efficacy measures. There were no significant differences between the two ondansetron groups. All three treatments were well tolerated. In conclusion, this large, multicentre study demonstrates that ondansetron is more effective than metoclopramide in the treatment of opioid-induced emesis following administration of post-surgical opioids to control pain.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Optimal control of long-term sedation during therapy in the intensive care unit is difficult to achieve in a number of patients when based on commonly used clinical sedation scores alone. We therefore used the median frequency of the EEG power spectrum as a quantitative measure for closed-loop administration of propofol in 21 artificially ventilated patients (nine trauma, 12 non-trauma). The EEG setpoint was correlated with a clinical sedation score and defined such, that mechanical ventilation was tolerated. The sedative therapy was given for 31±30 h. Non-trauma patients required sedation with an EEG median frequency between 2 and 3 Hz (propofol consumption: 1.4±0.8 mg kg−1h−1) and sedation seemed to follow some circadian patterns, whereas trauma patients needed significantly deeper sedation (EEG median frequency: 1-2 Hz; propofol consumption: 2.6±0.8 mg kg−1h−1). We conclude that the EEG closed-loop system could safely and reliably administer propofol to maintain a predetermined level of sedation for patients in intensive care unit over a protracted time.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We have compared the efficacy and safety of combined granisetron and droperidol with each anti-emetic alone for preventing post-operative nausea and vomiting after thyroidectomy. In a prospective, randomized, double-blind study, 180 women received granisetron 40 μg kg−1, droperidol 20 μg kg−1, or granisetron 40 μg kg−1plus droperidol 20 μg kg−1(n= 60 of each) intravenously immediately before induction of anaesthesia. A standard general anaesthetic technique and post-operative analgesia were used. A complete response, defined as no post-operative nausea and vomiting and no need for another rescue anti-emetic, during the first 24 h after anaesthesia occurred in 88%, 60% and 98% of patients who had received granisetron, droperidol and granisetron plus droperidol (P< 0.05; overall Fisher's exact probability test). No clinically important adverse events due to the drugs were observed in any of the groups. In summary, prophylactic use of combined granisetron and droperidol is more effective than each drug alone for the prevention of post-operative nausea and vomiting in female patients undergoing thyroidectomy.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

It has been suggested that epidural anaesthesia may increase blood flow in free flaps on the lower extremity. The objective of the present study was to test this hypothesis in 21 patients undergoing reconstructive surgery of the lower extremity with free muscle (n=8), fasciocutaneous (n=6) or musculocutaneous (n=7) flaps. Microcirculatory blood flow was measured continuously with a multichannel laser Doppler flowmetry, both in muscle and skin of the free flap as well as in the intact skin and muscle on the same extremity. After completion of surgery, general anaesthesia was continued and the epidural block was induced by an injection of 2% lignocaine-hydrochloride into a pre-operatively inserted and tested epidural catheter. The epidural block caused no change in microcirculatory flow in the intact skin and muscle, however, it resulted in a marked decrease in microcirculatory blood flow in all the free flaps studied (20-30%;P< 0.05). The epidural block also caused a significant decrease in mean arterial blood pressure, from 85 (±2.8) mmHg to 68 (±2.8) mmHg (P< 0.01). It was concluded that epidural anaesthesia may decrease microcirculatory blood flow in free flaps on the lower extremity by diverting flow away from the flap to normal intact tissues (a steal phenomenon).

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We compared the performance of the size 5 laryngeal mask airway in 20 paralysed anaesthetized male patients and 20 male cadavers (6-24 h post-mortem). Groups were matched for height and weight. Airway sealing pressure,in vivointracuff pressure and anatomical position (judged fibre-optically) were documented at zero volume and after each additional 10 mL up to 40 mL. All laryngeal mask airways were inserted at the first attempt and insertion times were similar. There were no differences in airway sealing pressure,in vivointracuff pressure or fibre-optic position between the groups. We conclude that the performance of the laryngeal mask airway is similar for fresh cadavers and paralysed anaesthetized patients. This may have implications for laryngeal mask airway research and training.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The aim of the study was to test the hypothesis that the requirement of sufentanil is reduced in elderly patients when the opiate is primarily used to facilitate mechanical ventilation in a medical intensive care unit. A further aim was to study whether elderly patients developed withdrawal symptoms after discontinuing prolonged sufentanil administration. We have studied prospectively two groups of patients requiring mechanical ventilation for more than 96 h; group 1 age < 60 years (n=316 or 68%) and group 2 age > 70 years (n= 150 or 32%). In all patients sufentanil and midazolam were administered continuously in order to facilitate ventilatory support. After an initial intravenous bolus injection of sufentanil 3.0-8.0 μg kg−1, the dosage was adjusted to the patients needs (0.75-1.0 μg−1kg−1h) using a modified Ramsey score by accepting between 3b and 4a as the end point. The amount of sufentanil administered and side effects were recorded at 24-h intervals. Seventy-two hours following the start of sedation with sufentanil/midazolam the dose of sufentanil required for sedation increased significantly (P< 0.05) in both groups when compared with the first 24 h. There was no statistical difference between the two groups in sufentanil requirement at any time during the study. This suggests that tachyphylaxis develops to a similar degree in patients in both age groups. In addition, weaning in the elderly was characterized by a similar degree of withdrawal-like symptoms suggesting that independent of age, there are similar receptor related reactions once the opiate is withdrawn.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A randomized double-blinded study consisting of 107 patients was conducted to compare the effect on post-operative pain relief of intra-articular fentanyl and intra-articular bupivacaine after knee arthroscopy. The results showed that intra-articular bupivacaine produced superior analgesia in the immediate post-operative period. At 2 h post-operatively, the intra-articular bupivacaine group had a mean pain score of 2.0 (standard deviation 2.1,P< 0.05) compared with the intra-articular fentanyl group which had a mean pain score of 3.2 (standard deviation 2.3,P< 0.05) After 2 h post-operatively, intra-articular bupivacaine and intra-articular fentanyl had a similar effect on pain scores. The mean pain score 18 h post-operatively was 2.7 for the intra-articular bupivacaine group (standard deviation 2.2,Pvalue 0.6) compared with the intra-articular fentanyl group which had a mean pain score of 2.8 (standard deviation 1.9,Pvalue 0.6).

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Aprotinin has been reported to influence positively or negatively the process of ischaemia-reperfusion. However, it is a complex drug acting on platelets, neutrophils and coagulation, which may also have a direct effect by inhibiting intracellular proteases and free radical generation. The goal of this study was to determine the direct effects of aprotinin on the myocardial performances of an isolated blood perfused rabbit heart preparation after normothermic global ischaemia. Two groups of 10 hearts were studied. The control group (ischaemia) underwent 30 min of global normothermic ischaemia. In the aprotinin group, (aprotinin) 200 KUI mL−1of aprotinin was added to the perfusate before ischaemia. Measurements were obtained at base-line, 10, 30 and 60 min after reperfusion. Normothermic ischaemia significantly decreased myocardial performance in both groups. After 60 min reperfusion, myocardial contractility significantly recovered in the aprotinin group compared with the ischaemia group. Aprotinin contributes significantly by limiting the consequences of ischaemia on myocardial performances. This effect may be due to a direct action of the drug because leucocytes and plasma proteins were removed in this preparation.

ISSN:0265-0215    

出版商:OVID    

年代:1999

数据来源: OVID