Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Feb 1982
Routine induction of anaesthesia with thiopental and suxamethonium: apnoea without ventilation?
Changes in Paco2 and Paco2 during the induction of anaesthesia with thiopental suxamethonium, and intubation were investigated in 20 patients who received preoxygenation for 2 min, but no ventilation before intubation. Both in fit patients below the age of 60 years (Group I) and in patients above the age-several suffering from cardiopulmonary disease - (group II), Pao2 increased to about 40 kPa during preoxygenation and remained at the level during apnoea. ⋯ No complications were seen, and it is concluded that the apnoea involved in the "crash induction" technique is sage. Pulmonary aspiration of acid gastric fluid may also occur in fasting patients, and it is suggested that even in elective cases ventilation might advantageously be replaced by preoxygenation when anaesthesia is induced with thiopental and suxamethonium.
-
Acta Anaesthesiol Scand · Oct 1981
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of epidural morphine and epidural bupivacaine for postoperative pain relief.
In 32 patients subjected to total hip replacement, postoperative pain relief was achieved by random treatment with either 5 mg of morphine in 10 ml of saline (n = 15) or 6-8 ml of 0.5% bupivacaine with epinephrine (n = 17), both drugs administered by the lumbar epidural route. In an additional group of 10 patients, post-traumatic thoracic or post-operative abdominal pain was relieved first by 4-6 ml of 0.5% bupivacaine with epinephrine and subsequently by 5 mg of morphine in 10 ml of saline, both drugs being administered by the thoracic epidural route. The duration of analgesia was significantly longer, on average, with morphine (28 h) than with bupivacaine (4.3 h) when the drugs were given by the lumbar route. ⋯ Plasma concentrations of morphine were not detectable 8 h after injection, though the patients still had pain relief. One case of delayed severe respiratory depression occurred 6 h after morphine injection via the thoracic route. Epidural morphine analgesia should therefore be reserved for patients in whom continual surveillance is possible, at least until more is known about the pharmacokinetics of narcotics in the epidural and subarachnoid space.
-
Acta Anaesthesiol Scand · Oct 1981
Comparative StudyComparison of physostigmine and neostigmine for antagonism of neuromuscular block.
The ability of physostigmine alone and in combination with neostigmine to reverse d-tubocurarine-induced neuromuscular block was evaluated in surgical patients. The relaxation was maintained at a level of 90% twitch suppression during balanced anesthesia, and antagonism was attempted with physostigmine 1.5 mg x 3; neostigmine 0.5 mg x 3; neostigmine 1.0 mg x 3; or with a combination of physostigmine 0.75 mg and neostigmine 0.5 mg x 3. The measured parameters included the twitch force or EMG amplitude of the adductor pollicis brevis muscle after supramaximal 0.1 Hz stimulation and fading of these responses after repetitive 2 and 50 Hz stimuli. ⋯ The addition of physostigmine to a subeffective dose of neostigmine resulted in antagonism comparable to that seen in other groups. The clinical antagonism was satisfactory in all patients receiving physostigmine. The divergence of relaxation-indicating parameters (twitch responses and fades) after physostigmine suggests dissimilar modes of action of two antagonists at the neuromuscular junction.
-
Acta Anaesthesiol Scand · Oct 1981
A new tracheostomy tube. III. Bronchofiberoptic examination of the trachea after prolonged intubation with the NL tracheostomy tube.
Recent publications show that severe damage to the trachea is still a problem with high-volume, low-pressure cuffs. The NL tracheostomy tube was used in 86 patients for 3 days to 2 months (mean 16 days). This tube has a high-volume, low-pressure cuff with automatic regulation of the cuff pressure at 3 kPa. ⋯ Four patients had ulcerations from suction catheters and four patients had small, superficial ulcerations produced by the tip of the tube. Of these last four patients, three had skin flaps that exerted pressure on the tube. Severe tracheal damage was prevented due to the combination of automatic regulation of cuff pressure and a flexible tip of the tube.