Ugeskrift for laeger
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Ugeskrift for laeger · May 1990
Review[Urinary retention in connection with postoperative pain treatment with epidural opioids].
The incidence of retention of urine in cases of postoperative epidural opioid analgesia varies from 15% to 90%. The extent to which this phenomenon depends upon the dosage employed has not been elucidated. The cause of postoperative retention of urine (PU) is probably a combination of the central and peripheral effect of the opiate involving altered autonomic activity. ⋯ Carbacholine is not effective in the treatment of postoperative retention of urine. In animal experimental studies, kappa-receptor agonists have an analgesic effect without urodynamic side-effects but no clinical trials on man have hitherto been undertaken. When postoperative retention of urine occurs after epidural opioid treatment, clean intermittent catheterization or introduction of a thin suprapubic catheter are recommended.
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Based on a review of the literature, hemodynamic signs and measurements in severe preeclampsia are described. Advantages and disadvantages of various hemodynamic methods and resulting indications for therapy are discussed. We found that in respect of hemodynamic monitoring in severe preeclampsia there are no indications for central venous pressure and conclude that at present there is no alternative to right heart catheterization (Swan-Ganz catheter).
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Ugeskrift for laeger · Sep 1989
Review[Immunologic consequences of surgery, anesthesia and blood transfusion. Surgical immunosuppression].
On the basis of the literature and the authors own investigations, the present article provides a brief schematic review of the fraction of the physiological immune response which has hitherto been investigated in connection with surgical trauma. Surgery, anaesthesia and blood transfusion induce temporarily acquired immune suppression and thus a potentially increased risk for postoperative infectious complications and recurrence after cancer surgery. ⋯ The clinical sequelae of preoperative and postoperative immune suppression are increased morbidity and mortality rates. Future research in this field must, therefore, be focussed on detailed investigation of the mechanisms which lead to postoperative immune suppression and development of methods to prevent these.
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Ugeskrift for laeger · Aug 1989
Review[Colloids versus crystalloids in the treatment of hypovolemic or septic shock].
The literature is reviewed with the aim of comparing the effect of resuscitation with colloid solutions with that of crystalloid solutions in the following patient categories: patients undergoing major elective abdominal surgery, patients in hypovolemic shock due to acute trauma and patients in septic shock. None of the clinical trials have documented that resuscitation with colloids is superior to that of crystalloids alone as regards mortality or frequency of complications. ⋯ Furthermore, resuscitation with colloids is about 50 times more expensive than resuscitation with crystalloids. On the basis of the clinical data and the higher cost of colloids, the authors recommend cessation of the use of colloids in the abovementioned conditions.
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On the basis of the literature, the development of war anaesthesiology is reviewed from the first war anaesthesia in 1847 until the present day. For nearly 100 years, ether was the main anaesthetic but, after the second world war, this was replaced by ketamine (Ketalar) which may be administrated by a simple injection or infusion. ⋯ Following a review of the advantages and disadvantages of ketamine as compared with inhalation anaesthesia under field conditions, it is concluded that ketamine is preferable in mobile units while larger and stationary units should have the possibility for employing current methods of anaesthesia also. A proposal is presented for standard anaesthesia in small units in situations in war and catastrophes.