摘要:

Tracheal and arterial CO2partial pressures were measured simultaneously in 27 laryngectomized patients both while they were awake and during high-frequency jet ventilation. Tracheal gas was sampled during brief interruptions of high-frequency jet ventilation. Agreement between tracheal and arterial CO2partial pressures was assessed using the Bland-Altman method. The tracheal-arterial CO2partial pressures gradient during spontaneous breathing was significantly lower (P<0.0002) than during high-frequency jet ventilation. During spontaneous ventilation, the bias was −0.77 kPa (95% CI= −0.99 to −0.55 kPa), and the upper and lower limits of agreement were 0.29 kPa (95% CI = −0.11 to −0.7 kPa) and −1.83 kPa (95% CI = −2.24 to −1.43 kPa). During high-frequency jet ventilation, the bias was −1.61 kPa (95% CI = −1.76 to −1.46 kPa), and the limits of agreement were −0.48 kPa (95% CI = −0.75 to −0.21 kPa) and −2.74 kPa (95% CI = −3.01 to −2.47 kPa). Despite the poor agreement between tracheal CO2partial pressure and arterial CO2partial pressure, it is sufficient to allow for adjustment of ventilator settings during jet ventilation.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Major knee surgery is associated with moderate or severe post-operative pain. Intrathecal morphine and continuous femoral 3-in-1 block were compared prospectively in 40 patients for pain after major knee surgery under spinal anaesthesia, with 4mL isobaric 0.5% bupivacaine. In a random order, 20 patients received preservative free morphine 0.3 mg mixed with spinal bupivacaine. In 20 patients, following spinal anaesthesia with only bupivacaine, femoral 3-in-1 block was performed post-operatively with 0.5% bupivacaine 2 mg kg−1. The block was continued via a catheter with 0.25% bupivacaine 0.1 mL h−1kg−1until the next morning (24 h after induction of spinal anaesthesia). Intramuscular oxycodone was given as a rescue analgesic in all patients. Two patients from the femoral group were excluded due to technical failure. Three patients in the morphine group and one patient in the femoral group did not need any additional oxycodone. In the morphine group on average 2.8 (range 0-7) and in the femoral group 3.2 (0-5) additional doses of oxycodone were needed during the 24 h observation period. The mean pain scores were significantly lower in the morphine group at 9 and 12 h into the 24-h trial. Itching was seen only in the morphine group (40% of the patients). Other side effects were similar in the two groups. All patients were satisfied with their pain therapy. Both intrathecal morphine and femoral 3-in-1 block alone were insufficient for the treatment of severe pain after major knee surgery.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

One hundred and three patients ASA grades I-II, 16-80 years of age scheduled for arthroscopic meniscectomy were prospectively studied, and randomly allocated to one of four groups: group 1 (n=25): 0.25% bupivacaine (50 mg) intra-articular (IA), group 2 (n=27): 1 mg of 0.1% preservative free morphine chloride in saline, group 3 (n=26): 1 mg of 0.1% preservative free morphine chloride in 0.25% bupivacaine and group 4(n=25): normal saline (0.9%). The volume given was always 20 mL. Ketorolac[Toradol®, 30 mg intra-muscularly (i.m.)] was used as rescue medication; analgesia was assessed using a visual analogue scale (VAS), a verbal rating scale(VRS), supplemental analgesic consumption post-operatively (SAC) and the presence of side effects. Verbal rating scale and visual analogue scale scores showed better pain control in group 1, 20 min after surgery, and in groups 1 and 2 at 4 h and 10 h as well as in the global VAS. In multifactorial analysis no significant differences among groups or side effects was found. pH analysis of the substances used showed no alterations in the basal pH range. The analgesic efficacy of 20 mL of bupivacaine 0.25% is similar to that of 1 mg of morphine in 20 mL of saline 0.9%. The morphine-bupivacaine mixture was no more efficacious than bupivacaine or morphine alone.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The objective of this prospective study was to determine the nocturnal/diurnal distribution of perioperative cardiac dysrhythmias in patients with coronary artery disease undergoing major vascular surgery. Eight patients with significant coronary artery disease undergoing major vascular surgery were studied. Continuous Holter monitoring was performed on each patient from approximately 1 h pre-operatively until 2-5 days post-operatively. Frequencies of isolated supraventricular and ventricular premature beats, and runs of supraventricular and ventricular premature beats were calculated for 6-h periods (00.00-06.00; 06.00-12.00; 12.00-18.00; 18.00-24.00 hours). Supraventricular tachycardia occurred significantly more frequently between 00.00 and 06.00 hours than during the other 6-h periods studied in the post-operative period following major vascular surgery.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The influence of acute moderate haemodilution on the relation between dose and response for rocuronium was evaluated in 60 adult patients, ASA grade I, undergoing elective plastic surgery. The patients were randomly allocated to either the control or the haemodilution group. Following the induction of general anaesthesia, the status of acute moderate haemodilution in the haemodilution group was achieved by draining venous blood, and intravenous infusion of lactated Ringer's solution, 6% dextran or gelofusine, during which the levels of haemoatocrit and haemoglobin dropped from 44% to 27.5% and from 148.3 to 91.3 g L−1, respectively. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12 s and the percentage depression of T1response was used as the study parameter. The relation between dose and response for rocuronium in the two groups was determined by the cumulative dose-response technique. The results showed that the dose-response curve for rocuronium during acute moderate haemodilution was shifted in a parallel fashion to the left and the potency of rocuronium was increased. There were significant differences in ED50, ED90and ED95between the two groups. The ED50, ED90and ED95of rocuronium in the haemodilution group was decreased by 28.2%, 35.4% and 38.8%, respectively, compared with the control group.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The effects of adding midazolam and bupivacaine to human cerebrospinal fluid in glass test tubes were examined by looking for changes in pH and a reduction in the transparency of the solution. Midazolam(n= 6), 0.25% bupivacaine (n= 6), 5 mg of midazolam in 6 mL of 0.25% bupivacaine (n= 6) and 5 mg of midazolam in 10 mL of saline(n= 6) were added to 1.5-mL samples (n= 24) of cerebrospinal fluid taken at the time spinal anaesthesia was begun. Transparency and pH were checked after each increment. Cerebrospinal pH was decreased to below 7.0 by adding more than 3 mg of midazolam, more than 1.9 mL of 0.25% bupivacaine or 1.3 mL of the mixture. Cerebrospinal transparency was decreased by adding more than 0.7 mg of midazolam, 1.1 mL of 0.25% bupivacaine or 0.6 mL of the mixture. Midazolam in saline neither decreased the pH below 7.0 nor reduced transparency. These results do not suggest that clinically useful doses of intrathecal or epidural midazolam are neurotoxic.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Lignocaine is a suitable and safe agent for intravenous regional anaesthesia (IVRA) with rapid onset of good surgical anaesthesia. The onset time of the local anaesthetic action of lignocaine was 11.2±5.1 min. Satisfactory surgical conditions, evidenced by good sensory blockade were achieved within 20 min, and no additional analgesics were required. There was no trend towards a fixed sequence, radial, median and ulnar in the development of sensory blockade. No patient exhibited objective symptoms of toxicity, either local or systemic, after release of the tourniquet, nor were there any subjective complaints. No changes in blood pressure, heart rate or oxygen saturation were observed at any time during the procedure, or after deflation of the tourniquet. After releasing the tourniquet lignocaine is rapidly and biexponentially eliminated, with a t1/2aof 4.3±2.1 min and a t1/2βof 79.1±31.2 min. Total body clearance was 0.86±0.39L min−1. Eight patients showed rapid release of lignocaine from the exsanguinated area. In two patients the systemic plasma concentration of lignocaine increased more slowly than in the remaining eight. This can be explained by a greater degree of lignocaine absorbtion in the tissues of the arm. Pharmacokinetic constants after rapid and slow absorption were calculated.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The aim of the present study was to evaluate the effects of neostigmine as a final anaesthetic manoeuvre on colonic anastomoses. A colonic anastomosis was constructed in 40 Sprague-Dawley rats. The animals were divided into two groups: (1) rats receiving intravenous saline solution (placebo); and (2) rats receiving an intravenous injection of neostigmine. The size of the caecum, and the diameters of the preanastomotic and post-anastomotic colon were measured during the operation and 4 days after surgery, when all the animals were sacrificed. At this time, the presence of adhesions was also investigated. Each segment containing an anastomosis was removed, and the bursting pressure and bursting wall tension were determined. Loss of caecum diameter was significantly greater in group 2 than in group 1 (P=0.03). Dilatation and obstruction of the colon were significantly more frequent in group 1 (dilatation,P=0.01; obstruction,P=0.047). Also, consumption of water by group 2 was greater than that by group 1 (P=0.049). No statistically significant differences were found between the diameters of the colon (pre- and post-anastomosis), or with respect to general adhesions and adhesions to the anastomotic line. No significant differences were found between anastomotic resistance (determined in terms of bursting pressure and bursting wall tension) in the two groups. The inclusion of neostigmine in an anaesthetic protocol under experimental setting did not reduce the resistance of colonic anastomoses and did not compromise normal healing. Moreover, obstruction caused by peristaltic weakness might be prevented by the expulsion of stool that is induced by the strong contraction of the colonic smooth muscle.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Pulmonary impairment is more frequent after cardiac surgery than after other major surgical procedures. The present study investigates whether, by using standard respiratory monitoring, i.e. side-stream spirometry and blood gas analysis, it is possible to detect changes in pulmonary function secondary to cardiopulmonary bypass. We investigated 18 patients undergoing elective coronary bypass surgery or aortic valve replacement. Cardiopulmonary bypass resulted in a nonsignificant increase in alveolar-arterial oxygen difference from 33.0 ± 10.6 kPa to 36.1 ± 12.5 kPa and arterial to end-tidal CO2tension difference from 0.67 ± 0.39 kPa to 0.79 ± 0.54 kPa. Respiratory system resistance was unaltered. In contrast, dynamic compliance decreased significantly after cardiopulmonary bypass from 78.6 ± 22.9 to 65.4 ± 22.4 mL cmH2O−1with open chest and from 61.0 ± 10.2 to 51.1 ± 17.2 mL cmH2O−1with closed chest, compared with corresponding values before cardiopulmonary bypass. In conclusion, pulmonary gas exchange was not compromised after cardiopulmonary bypass, but a diminished respiratory compliance was a consistent finding, even in uncomplicated cardiac surgery using routine respiratory monitoring.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A transoesophageal Doppler cardiac output monitor was used to study the cardiovascular changes occurring during laparoscopic cholecystectomy in patients without (group A) or with (group B) a history of cardiovascular disease, i.e. hypertension, ischaemic heart disease or heart failure. Insufflation of the abdomen with carbon dioxide caused significant (P<0.01) falls in mean cardiac index (17.9% in group A, 25.1% in group B) and mean stroke volume index (15.3% in group A, 21.2% in group B). Simultaneously, there was a significant(P<0.05) increase in mean systolic blood pressure (19.4%) in group A. There were no other differences in the cardiovascular responses of the two groups. There was no correlation between systolic blood pressure and either cardiac index or stroke volume index. No significant complications or morbidity were associated with the use of the transoesophageal Doppler monitor. We conclude that the cardiovascular changes associated with insufflation are neither predictable by clinical assessment nor adequately determined by routine monitoring. We recommend the transoesophageal Doppler monitor for use in this situation.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID