Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 1990
Randomized Controlled Trial Clinical TrialPredictable PaCO2 with two different flow settings using the Mapleson D system.
Two different settings of fresh gas flow (VFG) and minute ventilation (VE) used with the coaxial Mapleson D system (Bain), were evaluated in 59 adults (ASA I-III) during controlled ventilation and different types of surgical procedures. The two flow settings (alternatives A and B) were VFG of 75 and 110 ml.min-1.kg-1 and VE of 150 and 175 ml.min-1.kg-1, aiming to generate normocapnea and mild hypocapnea, respectively. ⋯ With alternative B, the PaCO2 was 4.4 +/- 0.5 kPa, with 82% of the patients within the range 3.5-4.9 kPa. It is concluded that these two flow regimes are suitable for clinical use when either normocapnea or mild hypocapnea is desired.
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Acta Anaesthesiol Scand · Apr 1990
Cardiopulmonary complications in high-risk surgical patients: the value of preoperative radionuclide cardiography.
In a prospective study we examined the strength of association between preoperative left ventricular performance measured by radionuclide cardiography in patients with cardiac or pulmonary insufficiency (high-risk patients) and cardiopulmonary complications associated with anaesthesia and surgery. Detailed pre-, intra- and postoperative data collected for 7306 anaesthetized patients were included in the study. One hundred and thirty-one patients (1.8%) were classified as high-risk patients, and 95 patients were examined with radionuclide cardiography. ⋯ Patients admitted to major surgery with LVEF less than 50 or greater than 70% were at greater risk than patients with LVEF = 50-70% as demonstrated by a significant increase in the total incidence of cardiopulmonary complications, 70% vs. 17%. It is appropriate to measure LVEF in patients admitted for major surgery who have an increased risk of cardiopulmonary complications as clinically evidenced by heart failure or severe ischaemic heart disease. As the predictive information given by LVEDV was less than that given by LVEF, there are no clinical reasons for measurement of LVEDV.
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Acta Anaesthesiol Scand · Feb 1990
Randomized Controlled Trial Comparative Study Clinical TrialVisceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine.
In a randomized study, the incidence of visceral pain was evaluated in 46 patients undergoing elective caesarean section under spinal or epidural anaesthesia with 0.5% bupivacaine. If the patient experienced pain during the operation, a standard visual analogue scale ranging from 0 to 10 was used to assess the degree of pain. Visceral pain occurred in 12/23 patients in the spinal group and in 13/23 patients in the epidural group. In neither group was a correlation found between the cephalad level of analgesia or the intensity of cutaneous analgesia in the sacral region, and the presence of visceral pain.
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Acta Anaesthesiol Scand · Feb 1990
Case ReportsPrilocaine-induced methemoglobinemia evidenced by pulse oximetry.
Methemoglobinemia was suspected in a healthy 19-year-old woman, when the pulse oximeter reading (SpO2) was 88% after a plexus brachialis block with 550 mg (35 ml, 1.5%) prilocaine. The patient was receiving 50% oxygen, and the PaO2 was 48.6 kPa (365 mmHg). After start of methylene blue treatment, with a total dose of 1 mg/kg, the SpO2 showed a gradual increase. This case report emphasises the potential advantage of arterial oxygen saturation monitoring with a pulse oximeter, but also the importance of the correct interpretation of the SpO2 reading.
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Acta Anaesthesiol Scand · Feb 1990
A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity.
The aims of this study were: 1) to describe the frequency and type of cardiopulmonary complications, 2) to identify factors significantly associated with cardiovascular and pulmonary complications associated with anaesthesia and surgery, and 3) to estimate the total risk of cardiopulmonary complications for an anaesthetic when a combination of risk factors is present. Seven thousand three hundred and six anaesthetized patients undergoing gastrointestinal, urological, gynaecological, and orthopaedic surgery were included in the study; 6.3% (1:16) had one or more cardiovascular complications requiring intervention associated with anaesthesia and surgery, and 4.8% (1:21) had pulmonary complications. The total incidence of patients with one or more complications associated with anaesthesia and surgery was 9.4% (1:11). ⋯ The extent of pulmonary complications following anaesthesia and surgery was significantly correlated to patients aged greater than or equal to 70 years, preoperative chronic obstructive lung disease (COLD), major surgery, and to general anaesthesia involving muscle relaxants. Attempts to estimate the cardiopulmonary complications which may accompany anaesthesia and surgery provided important information about the anaesthetic course and outcome. With our model it seems possible to distinguish between very different levels of cardiopulmonary risk in the anaesthetic patient.