ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03232.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03411.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A total of 434 patients admitted to the intensive care unit for mechanical ventilation were followed prospectively to investigate the influence of a nasotracheal tube on the paranasal sinuses. Twenty‐five patients died before the examination was completed. The rest were examined for clinical symptoms of sinusitis. If sinusitis was suspected or the patients were intubated for 5 days or more, an x‐ray of the sinuses was performed. In patients intubated for less than 5 days (N = 357), sinusitis was clinically suspected in three, but radiograph‐ically verified in only one. In patients intubated for 5 days or more (N = 47), 23 (49%) had affection of the paranasal sinuses. Patients needing a nasotracheal tube should be examined for sinusitis if they are intubated for more than 5 days or if unexplained fever, sepsis or purulent nasal secretion develops. If the suspicion is confirmed, the nasotracheal tube should be re

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03233.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This study was undertaken to evaluate the efficacy and the safety of transnasal butorphanol (TNB) compared to intravenous butorphanol (IVB) in 186 patients experiencing moderate to severe post‐cesarean section pain. Patients were randomly assigned to five groups in a double‐blind fashion: Group I (n = 37) received 2 mg IVB, Group II (n = 38) 2 mg TNB, Group III (n = 36) 1 mg TNB followed by a repeat dose of 1 mg TNB at 60 min, Group IV (n = 38) 0. 5 mg TNB followed by a repeat dose of 0. 5 mg at 60 min, and Group V (n = 37) received placebo. All administrations were double dummy. Pain intensity and relief were noted and the incidence of side effects was recorded. Remedication with the same study drug was allowed up to 72 h. Onset of analgesia was more rapid in the 2 mg IV group compared to the three TN groups: 5 min vs 15 min, respectively. However, the 2 mg and the 1–1 mg TN groups had a longer duration of analgesia, approximately 4. 5 h, compared to 3. 0 h for the 2 mg IV group (P<0. 05). Somnolence was dose related and was the most frequent side effect, and was less frequent when the TN dose was divided into 2 doses administered 1 h apart. Multiple doses of TNB and IVB were safe and clinically acceptable up to 3 days at all doses studied. There were no incidences of nasal mucosa irritation, or cardiovascular or respiratory depression. It is concluded that transnasal butorphanol represents a safe and effective alternative to injectable butorphanol for post‐cesarean section pain and offers a better and longer duration of analgesia compared to IV butorphanol. The optimum dose seems to be 2 mg TN butorphanol and it is tolerated better when divided into 1 mg increments, given 1

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03234.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Severe respiratory failure is always associated with a defect in the surfactant system. Surfactant substitution in newborn infants with respiratory distress syndrome (RDS) has gained worldwide acceptance. In the present study, we have evaluated whether surfactant diagnostics are of use in choosing recipients of exogenous surfactant. In addition, we studied whether factors apparently unrelated to surfactant influence the degree of respiratory failure and surfactant responsiveness. In small preterm infants, the surfactant indices in amniotic fluid (L/S ratio and phosphatidylglycerol), within 3 days of birth, predicted the risk of RDS with a sensitivity of 90–100%, and a specificity of 50–85%. The surfactant indices, measured in BAL, predicted the risk of ARDS (which became evident 1 to 7 days later) with a sensitivity of 50–60% and a specificity of 59–65%. In small preterm infants with RDS, the amount of fluids given during the first day correlated positively with the degree of respiratory failure and negatively with the degree of surfactant responsiveness. According to an experimental study, in hydrostatic lung edema, exogenous surfactant is diluted by edema fluid and becomes sensitive to inhibitors of surfactant function. Beside dosage, quality, and time of administration, the management of patients largely dictates the responsiveness to exogenous sur

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03395.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

In a double‐blind study, propofol (P) 2–2. 5 mg‐kg‐1preceded by saline (Sal) or alfentanil (A) 20–30 Hg kg‐1was used for anaesthetic induction in 59 young patients of ASA physical class I or II, premedicated with oxycodone 0. 1 mg‐kg‐1and atropine 0. 01 m. kg‐1i. m. The patients were randomly allocated to one of the four groups: Group 1 Sal + P2. 5, Group 2 A20 + P2. 5, Group 3 A30 + P2. 5 and Group 4 A30 + P2. Pain on injection of propofol occurred in 67, 36 and 7% of the patients in the Sal + P2. 5, A20 + P2. 5 and A30 + P2 groups, respectively, but not at all in the A30 + P2. 5 group. Intubating conditions were assessed as good, moderate, poor or impossible on the basis of jaw relaxation, ease of insertion of the tube and coughing on intubation, each on a three‐point scale. In impossible cases, suxamethonium was used. In the Sal + P2. 5 group, the frequencies of good, moderate, poor and impossible intubating conditions were 0, 38, 8 and 54%, respectively. The corresponding figures in the A30 + P2. 5 group were 43, 46, 7 and 14% (P<0. 05 between the groups). The other groups did not differ significantly from the Sal + P2. 5 group. After injection of propofol, both systolic and diastolic arterial pressures decreased significandy in all other groups, with the exception of diastolic pressure in the Sal + P2. 5 group, whereas heart rate did not differ from the control level. After intubation, systolic arterial pressure increased statistically significantly in the Sal + P2. 5 and A30 + P2 groups and diastolic arterial pressure in all other groups with the exception of the A30 + P2. 5 group when compared with the corresponding preceding values. After intubation, heart rate decreased significantly in the A30 + P2. 5 and A30 + P2 groups. The mean QTc interval of the ECG was always in the normal range. It is concluded that the best method was the combination of alfentanil 30 Ug‐kg‐1and propofol 2. 5 mg'kg“‘. It caused no pain on injection of propofol, offered satisfactory (good or moderate) intubating conditions in 79% of the patients and prevented the cardiov

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03235.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Lung structure and function, and the effect of surfactant replacement, were studied in three animal models of adult respiratory distress syndrome (ARDS): surfactant depletion by repeated lung lavage, proteinaceous pulmonary edema induced by prolonged exposure to hyperoxia, and inoculation with hybridoma making an antibody to the hydrophobic surfactant‐associated protein, SP‐B. Surfactant replacement therapy restored normal gas exchange in respiratory failure induced by repeated lung lavage but was ineffective in animals with severe lung parenchymal lesions induced by hyperoxia or antibody to SP‐B. Lung edema fluid from animals exposed to hyperoxia inhibited surfactant function in a concentration‐dependent manner. These observations indicate that, in experimental ARDS, the effect of surfactant replacement depends on the type of animal model and, especially, on the degree of lung injury present at the time of

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03396.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

In two double‐blind, placebo‐controlled investigations, morphine and lidocaine were administered perineurally to the ulnar nerve. Thresholds (warmth and pain) and pain‐evoked brain potentials (amplitude and latency) to argon laser stimulation were measured up to 120 min after the injection. Hypalgesia to laser pain was detected 15 min after the injection of morphine and 5 min after the injection of lidocaine. The duration of hypalgesia and analgesia was less than 15 min for morphine and 85 min for the lidocaine injection. Both morphine and lidocaine increased the latency of the brain potentials, which indicates that the same blocking mechanisms could be involved. Pin‐prick analgesia was obtained 5 min after the injection of lidocaine, but 15–30 min elapsed before the laser pain was inhibited maximally. Laser pulses can activate larger skin areas than needle pricks, indicating that a central summation of the activity from many cutaneous nociceptors is important in order to obtain a reliable indicator of adequate

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03236.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03397.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Neither epidural (EDA) or intrathecal (IT) morphine nor EDA opiate + bupivacaine provides acceptable relief of some types of cancer pain, e. g. pain originating from mucocutaneous ulcers, deafferentation pain, continuous and intermittent visceral and ischaemic pain, and that occurring with body movement as a result of a fracture. To improve pain relief in such conditions, we gave combinations of morphine and bupivacaine through open IT‐catheters to 52 patients with “refractory”, severe (VAS 7–10 out of 10), complex cancer pain (Edmonton Stage‐3), for periods of 1–305 (median = 23) days. The efficacy of the treatment was estimated from: 1) daily dosage (intraspinal and total opiates, and intraspinal bupivacaine), and 2) scores of non‐opiate analgesic and sedative consumption, gait and daily activities, and amount and pattern of sleep. Forty‐four patients obtained continuous and acceptable pain relief (VAS 0–2), 26 of them with daily doses of IT‐bupivacaine of<30 mg/day (60–305 mg/day), not always giving acceptable pain relief, were necessary in 13 patients with deafferentation pain from the spinal cord or brachial or lumbosacral plexuses or pain from the coeliac plexus, or from large, ulcerated mucocutaneous tumours. By combining IT‐bupivacaine with IT‐morphine, it was possible to use relatively low IT‐morphine doses (10–25 mg/day during the first 2 months of treatment) in more than half of the patients. The IT‐treatment significantly decreased the total (all routes) opiate consumption and significandy improved sleep, gait and daily activities. For the whole period of observation (6 months), the IT‐treatment was assessed as adequate in 3. 8%, good in 23. 1%, very good in 59. 6% and excellent in 13. 5% of the cases. Adverse effects of the IT‐bupivacaine (paraesthesiae, paresis, gait impairment, urinary retention, anal sphincter disturbances and orthostatic hypotension) did not occur with doses of

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03237.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY