Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2003
Randomized Controlled Trial Comparative Study Clinical TrialSeizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy.
The object of this study was to test whether substituting part of the methohexital dose with the short-acting opioid remifentanil would prolong seizure duration in middle-aged patients while providing a similar depth of anesthesia as with methohexital alone. This has been reported for the combined use of methohexital and remifentanil in elderly patients, but has not been investigated in middle-aged patients likely to require a higher total dose of methohexital for inducing anesthesia. ⋯ Substituting part of the methohexital dose with remifentanil is a useful anesthetic technique to prolong seizure duration in middle-aged patients requiring a 1.5-fold higher induction dose of methohexital than elderly patients, the only population studied to date for the combined use of methohexital and remifentanil in ECT.
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Acta Anaesthesiol Scand · Oct 2003
Randomized Controlled Trial Comparative Study Clinical TrialPCEA compared to continuous epidural infusion in an ultra-low-dose regimen for labor pain relief: a randomized study.
Patient-controlled epidural analgesia, PCEA, has been introduced in obstetric analgesia during the past decade. Many studies have shown that the consumption of analgesic is reduced when the parturient requests her own doses. This study investigates whether this is also true when using an ultra-low-dose regimen. ⋯ PCEA reduces doses compared to continuous infusion even when ultra-low-dose local anesthetic with opioid is used. The PCEA technique provides individual titration of doses to an acceptable degree of pain relief.
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Acta Anaesthesiol Scand · Oct 2003
Randomized Controlled Trial Clinical TrialDifferences among forced-air warming systems with upper body blankets are small. A randomized trial for heat transfer in volunteers.
Forced-air warming is known as an effective procedure in prevention and treatment of perioperative hypothermia. Significant differences have been described between forced-air warming systems in combination with full body blankets. We investigated four forced-air warming systems in combination with upper body blankets for existing differences in heat transfer. ⋯ Based on an estimated heat loss from the covered area of 38 W the heat balance is changed by 46.1 W to 55 W by forced-air warming systems with upper body blankets. Although the differences in heat transfer are significant, the clinical relevance of this difference is small.
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Acta Anaesthesiol Scand · Sep 2003
Randomized Controlled Trial Clinical TrialEffects of 0.5 and 1.0 MAC isoflurane, sevoflurane and desflurane on intracranial and cerebral perfusion pressures in children.
Isoflurane has been a commonly used agent for neuroanesthesia, but newer agents, sevoflurane and desflurane, have a quicker onset and shorter emergence from anesthesia and are increasingly preferred for general pediatric anesthesia. But their effects on intracranial pressure (ICP) and cerebral perfusion pressure (CPP), especially in pediatric patients with already increased ICP, have not been well documented. ⋯ 0.5 and 1.0 MAC isoflurane, sevoflurane and desflurane in N2O all increased ICP and reduced MAP and CPP in a dose-dependent and clinically similar manner. There were no baseline dependent increases in ICP from 0 to 1.0 MAC with isoflurane or sevoflurane, but ICP increased somewhat more, although statistically insignificant, with higher baseline values in patients given desflurane. The effect of MAP on CPP is 3-4 times higher than the effect of the increases in ICP on CPP and this makes MAP the most important factor in preserving CPP. In children with known increased ICP, intravenous anesthesia may be safer. However, maintaining MAP remains the most important determinant of a safe CPP.
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Acta Anaesthesiol Scand · Sep 2003
Randomized Controlled Trial Clinical TrialPatient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression.
The aim of the study was to evaluate postoperative analgesia and safety of wound instillation of ropivacaine either by a single dose or a patient-controlled regional anaesthesia (PCRA) technique. ⋯ Preoperative intrabursal prilocaine with epinephrine + postoperative subacromial administration of ropivacaine by PCRA-technique provided the most effective analgesia with no major side-effects. The free plasma concentrations of ropivacaine were far below toxic concentrations.