Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1997
Contradictory effects of dopamine at 32 degrees C in pigs anesthetized with ketamine.
In critically ill patients who were surface cooled to 33 +/- 2 degrees C, we have observed that dopamine sometimes causes a substantial decrease in blood pressure. The present study was designed to compare the effects of dopamine in normothermia to those seen after surface cooling to 32 degrees C. ⋯ Dopamine increased CO and MAP in normothermia but not at 32 degrees C, where there was even a significant reduction of MAP in this porcine model.
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Acta Anaesthesiol Scand · Oct 1997
Randomized Controlled Trial Clinical TrialLaryngeal mask bite blocks--rolled gauze versus Guedel airway.
Biting on the silicone tube and pilot balloon of the laryngeal mask airway (LMA) may obstruct or damage them with the teeth and a bite block is recommended. The recommended bite block is a wad of gauze swabs rolled into a cylindrical shape and placed alongside the LMA. It is considered that this avoids irritating the posterior pharyngeal wall and damage to teeth whilst supporting the LMA tube when taped to it. The Guedel airway is commonly used as a bite block with the tracheal tube and many anaesthetists also use it with the LMA. The aim of the following study was to compare rolled gauze swabs with a Guedel airway as a bite block for the LMA. ⋯ 1. The Guedel airway is an unsuitable bite block for the LMA. 2. Cuff pressure limitation is compatible with adequate ventilation. 3. The combination of LMA and Guedel airway probably prevents either from sitting in the correct anatomical position.
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Acta Anaesthesiol Scand · Oct 1997
Case ReportsRupture of the left main-stem bronchus by the tracheal portion of a double-lumen endobronchial tube.
We report a rupture of the left main-stem bronchus following the insertion of a left-sided double-lumen endobronchial tube in a 76-yr-old woman with a short trachea. A fiberoptic bronchoscope was not used during the initial insertion of the tube and the depth of insertion resulted in approximately 5 cm in excess of the optimal level for this patient. The rupture had been caused by the tracheal portion of the double-lumen tube. This damage may have been avoided if a fiberoptic bronchoscope was used routinely as an introducer and for positioning of the endobronchial tube under direct vision.
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Acta Anaesthesiol Scand · Oct 1997
Randomized Controlled Trial Clinical TrialMapping of punctuate hyperalgesia around a surgical incision demonstrates that ketamine is a powerful suppressor of central sensitization to pain following surgery.
Tissue injury induces central sensitization in the spinal cord dorsal horn neurons via mechanisms involving N-methyl-D-aspartate (NMDA) receptors, leading to secondary hyperalgesia. Using punctuate mechanical hyperalgesia as a measure of central sensitization, we examined whether induction and maintenance of central sensitization after surgery could be prevented by a low-dose infusion of the NMDA-receptor antagonist ketamine. ⋯ Low-dose i.v. infusion of ketamine during and after surgery reduces mechanical punctuate hyperalgesia surrounding the surgical incision. These results indicate that blockade of NMDA receptors prevents the central sensitization caused by nociceptive input during and after surgery.