Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1995
Randomized Controlled Trial Clinical TrialIntra-arterial regional anaesthesia for hand surgery with alkalinized 0.5% lignocaine.
Intra-arterial regional anaesthesia (IARA) for hand surgery is an old, forgotten technique. One of the causes of low popularity may be a scalding sensation in the hand during intra-arterial injection of lignocaine, which may be caused by low pH of lignocaine's solution. In this randomized, double-blind study, normal (pH 5.2-5.3) or alkalinized (pH 7.2-7.3) preservative-free 0.5% lignocaine 1.5 mg kg-1 was injected into the radial arteries of forty adult patients to produce anaesthesia for ambulatory hand surgery. ⋯ Nine patients in group 1 and seven in group 2 developed minor bruises after cannulation (NS). No other sequelae of intra-arterial injections were observed. We conclude that alkalinized 0.5% lignocaine was less painful on injection than normal lignocaine and should be preferred for intra-arterial anaesthesia for hand surgery.
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Acta Anaesthesiol Scand · Nov 1995
Hyperkalaemia associated with haemorrhagic shock in rabbits: modification by succinylcholine, vecuronium and blood transfusion.
In haemorrhagic patients, hyperkalaemia may occur after succinylcholine administration. We investigated in haemorrhagic rabbits whether vecuronium caused hyperkalaemia and if blood transfusion prevented succinylcholine-induced hyperkalaemia. Rabbits were lightly anaesthetized with halothane/N2O and 30-35 ml/kg blood were withdrawn to cause arterial pH to decrease to approximately 7.0-7.1. ⋯ The K+ increase at 5 min for Group S (1.8 +/- 0.8) was significantly higher than those for Group C (1.0 +/- 0.6) or Group V (0.9 +/- 0.4), but was not different from that of Group T (1.5 +/- 0.7). We conclude that haemorrhage and succinylcholine cause hyperkalaemia in rabbits. Muscle relaxation itself does not appear to be a factor, but transfusion may lessen the hyperkalaemia.
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Acta Anaesthesiol Scand · Nov 1995
Resistance to atracurium in rats with experimental inflammation: role of protein binding.
The influence of altered protein binding on the neuromuscular effect of atracurium has been studied in rats with experimental inflammation induced by subcutaneous injection of turpentine oil. Doses of atracurium ranging from 0.45 to 1.5 mg.kg-1 were administered to control (n = 30) and to experimental inflammation induced rats (n = 30). Neuromuscular transmission was monitored by recording the twitch tension of the tibialis-anterior muscle elicited by stimulation of the sciatic nerve. ⋯ For equipotent doses ED95 (defined as the effective dose eliciting 95% of maximum effect), no differences were found in recovery time and duration of action between the two groups of rats. Mucoproteins levels (index of alpha 1-acid glycoprotein (AAG) and protein binding were significantly increased in rats with experimental inflammation as compared to control rats. Based on these results, altered serum protein binding of atracurium appears to be responsible, at least in part, for the resistance to atracurium.
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Thoracic paravertebral nerve blockade, although once widely practised, has now only a few centres which contribute to the literature. Data production has, however, continued and this review correlates this new information with existing knowledge. Its history, taxonomy, anatomy, indications, techniques, mechanisms of analgesia, efficacy, contraindications, toxicity, side effects and complications are reviewed. ⋯ For unilateral surgery of the chest or truck, thoracic paravertebral analgesia should be considered as the afferent block of choice. For bilateral surgery, its efficacy may be limited by the doses of local anaesthetic which could safely be used and further study in this area in particular is required. This form of afferent blockade deserves greater consideration and investigation.