Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 2004
Comparative StudyDesflurane results in higher cerebral blood flow than sevoflurane or isoflurane at hypocapnia in pigs.
In clinical neuroanaesthesia, the increase in cerebral blood flow (CBF) and intracranial pressure caused by the cerebral vasodilative effects of an inhalational anaesthetic agent is counteracted by the cerebral vasoconstriction induced by hypocapnia. Desflurane and sevoflurane may have advantages over the more traditionally used isoflurane in neuroanaesthesia but their dose-dependent vasodilative effects at hypocapnia have not been compared in the same model using truly equipotent minimal alveolar concentrations (MACs). ⋯ More cerebral vasodilation at hypocapnia with high doses of desflurane than with sevoflurane or isoflurane indicates that desflurane might be less suitable for neuroanaesthesia than sevoflurane and isoflurane.
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Acta Anaesthesiol Scand · Apr 2004
Changes in diaphragm structure following prolonged mechanical ventilation in piglets.
Prolonged mechanical ventilation and inactivity negatively affect muscle function. The mechanisms for this dysfunction are unclear and clinical studies of respiratory muscle are difficult to carry out. An animal model simulating the critical care environment was used to investigate the effects of 5 days' mechanical ventilation and diaphragm inactivity on diaphragm muscle morphology. ⋯ Five days' mechanical ventilation with sedation and complete diaphragm inactivity resulted in changes in muscle fiber structure. A causal relationship can not be concluded but the acute changes in fiber type distribution and structure suggest that previously reported diaphragm contractile impairment occurs at the level of muscle fibers.
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Acta Anaesthesiol Scand · Apr 2004
Randomized Controlled Trial Clinical TrialImproved application of Lidocaine/Prilocaine cream in children. A randomized and prospectively controlled study of two application regimes.
Intravenous cannulation in children aged 6-12 years is less painful after a 90-min application of a Lidocaine/ Prilocaine cream followed by a 30-min interval without cream, than cannulation immediately after a 60-min application. ⋯ i.v. cannulation after application of anaesthetic cream for 90 min followed by a 30-min interval is less painful than the widely used 60-min application directly followed by cannulation.
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Acta Anaesthesiol Scand · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache.
The incidence of headache after spinal anaesthesia has varied greatly between studies. We compared the incidence of postoperative headache in general and postdural puncture headache (PDPH) when using 27-gauge (G) (outer diameter 0.41 mm) Quincke and Whitacre spinal needles in ambulatory surgery performed under spinal anaesthesia. ⋯ True PDPH seldom occurs when a 27-G (0.41 mm) spinal needle is used, although postoperatively a non-specific headache is common. Using the 27-G (0.41 mm) Whitacre spinal needle further reduced the incidence of PDPH. Thus, we recommend routine use of the 27-G (0.41 mm) Whitacre spinal needle when performing spinal anaesthesia.
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Acta Anaesthesiol Scand · Apr 2004
Case ReportsConvulsions on anaesthetic induction with sevoflurane in young children.
Increased worldwide use for paediatric anaesthesia of the volatile anaesthetic agent sevoflurane has mainly resulted from its low blood-gas partition coefficient and low airway irritability, providing smooth conditions for rapid induction of anaesthesia. Nevertheless, there are several clinical and experimental reports suggesting a correlation between exposure to sevoflurane and generalized clonic or tonic seizure activity. We report two clinical episodes of convulsions associated with the induction of sevoflurane anaesthesia in young children. ⋯ Both episodes ceased spontaneously. Although no EEG was recorded, it cannot be excluded that both episodes resulted from seizure activity within the CNS. Based on our observations and reports by others we suggest that, until further notice, sevoflurane should be avoided or at least used cautiously in patients where clinical epileptic activity has been verified or is strongly suspected.