Acta anaesthesiologica Scandinavica
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Segmental epidural analgesia (T10-T12) was performed in 418 parturients, using a 4-6 ml dose of 0.5% bupivacaine, with or without adrenaline. Seventy per cent of parturients were primiparas and 30% had histories, or signs, of possible uteroplacental insufficiency. Our aim was to relieve pain during the long passive opening phase, so that mothers would be rested and active at the beginning of the second phase, but also to avoid abolishing the bearing-down reflex, the absence of which causes an increased frequency of instrumental delivery. ⋯ Slight, but rapidly correctable, hypotension occurred in 16.5%, and in two cases the hypotension led to more serious complications. This stresses the importance of the availability and competence of both the anaesthetic and obstetric teams. There were no maternal or neonatal mortalities, and the Apgar scores compared well with the figures for the normal material in our obstetric unit.
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Acta Anaesthesiol Scand · Jan 1977
Comparative StudyThe cerebrovascular CO2 reactivity during the acute phase of brain injury.
Using the intra-arterial 133xenon (133Xe) method, the cerebrovascular response to acute Paco2 reduction was studied in 26 unconscious, brain-injured patients subjected to controlled ventilation. The CO2 reactivity was calculated as delta in CBF/delta Paco2. The perfusion pressure was defined as the difference between mean arterial pressure and mean intraventricular pressure. ⋯ An increase of the CO2 reactivity with time was observed, indicating normal response after 1-2 weeks. Chronic hypocapnia in six unconscious patients resulted in sustained CSF pH adaptation. The question whether a delay in CSF pH adapation exerts an influence on the CO2 reactivity, and the influence of cerebral lactacidosis on the CO2 response are discussed.
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Acta Anaesthesiol Scand · Jan 1977
General anaesthesia or lumbar epidural block for caesarean section? Effects on the foetal heart rate.
Caesarean section was performed in 10 patients under general anaesthesia and in 10 other patients under epidural block. The foetal heart rate was monitored continuously during anaesthesia and operation with a scalp electrode and a cardiotocograph. There was no major difference between the two anaesthetic techniques in their effect on the foetal heart rate. ⋯ The operative time was longer in the epidural group than in the general anaesthesia group, due to a higher frequency of Pfannenstiel incisions and repeat caesarean sections in the epidural group. Clinically, all newborns seemed to be unaffected, with normal Apgar scores. Epidural block seems to be a good alternative to general anaesthesia for caesarean section, particularly when a long operative time is expected.
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Acta Anaesthesiol Scand · Jan 1977
Comparative StudyHuman hepatic blood flow and its relation to systemic circulation during intravenous infusion of bupivacaine or etidocaine.
Fifteen healthy young volunteers were studied before and during an intravenous infusion of a local anaesthetic agent. Seven received bupivacaine and eight etidocaine in a dose rate of 2 mg/min over a period of 150 min. Variables of the central systemic circulation and also the hepatic blood flow were measured repeatedly. ⋯ In contrast, these three drugs had the same decreasing effect upon the splanchnic vascular resistance, which caused an almost identical increase in the estimated hepatic blood flow. The calculated vascular resistance in the systemic circulation, excluding the splanchnic, was unchanged during the infusion of etidocaine, while it decreased during the infusion of bupivacaine. Most of this discrepancy was due to the different plasma concentrations of the drugs.
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Acta Anaesthesiol Scand · Jan 1977
Glomerular filtration rate during halothane anaesthesia and epidural analgesia in combination with halothane anaesthesia.
Pre- and peroperative determination of glomerular filtration rate (GFR) was performed in nine patients operated during light halothane anaesthesia (group A) and in nine patients operated during epidural analgesia in combination with light halothane anaesthesia (group B). In group A, the mean GFR decreased insignificantly by 7% and the mean arterial blood pressure increased significantly by 10%. In group B, the mean GFR decreased significantly by 19% and the mean arterial blood pressure decreased significantly by 15%. It is suggested that the difference in change in GFR between the two groups was caused by differences in mean arterial blood pressure.