Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 1981
Randomized Controlled Trial Comparative Study Clinical TrialEpidural morphine for postoperative pain relief.
Thirty-three patients were randomly assigned to two groups to study the analgesic potency, duration of action and side effects of epidural and intramuscular morphine after hip surgery. Two milligrams of preservative-free morphine chloride in 10 ml of normal saline in the epidural space was compared to 10 mg of intramuscularly administered morphine. There was a more rapid onset of action after intramuscular morphine. ⋯ Nausea and/or vomiting was less common after epidural morphine (20% versus 55%). Pruritus or respiratory depression which have been reported previously were not encountered. However, it is recommended that preservative-free solution are used to avoid itching and that the patients are monitored, as respiratory depression may occur long after administration of epidural opiate.
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Acta Anaesthesiol Scand · Apr 1981
Interscalene brachial plexus block: area of analgesia, complications and blood concentrations of local anesthetics.
In a prospective clinical study including 100 patients, the consequences of using the interscalene approach to block the brachial plexus were investigated according to the area of analgesia, complications, and blood concentrations of local anesthetics. Sufficient analgesia of the shoulder and the upper part of the arm was obtained in 98-99% of the cases, whilst the area of analgesia in the forearm and the hand was more variable. ⋯ No toxic reactions were seen. The complications were in accordance with those reported in other publications.
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Acta Anaesthesiol Scand · Apr 1981
Central haemodynamics and oxygen transport with and without continuous positive pressure ventilation after open-heart surgery.
Twelve patients, subjected 20 h earlier to coronary artery bypass surgery, were studied on discontinuation of the postoperative mechanical ventilation employing PEEP+5 cmH2O (CMV+PEEP). Compared to the values obtained during CMV+PEEP, cardiac index and mixed venous blood oxygen tension increased with change to spontaneous ventilation at ambient pressure, employing a 28% O2 Ventimask for the intubated patient. ⋯ The observations suggest that after open-heart surgery, CMV using a PEEP as low as +5 cmH2O may exert, in comparison to controlled oxygen therapy ;during spontaneous breathing, a significant lowering effect on the already compromised cardiac performance. This necessitates continuous weighing of the beneficial effects obtained by employing postoperative CMV+PEEP, against the adverse haemodynamic effects, although the alterations in cardiac output may partly ensue from the changes in metabolism, muscular effort and oxygen consumption during the two modes of ventilation, although there was no significant increase in oxygen consumption.
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The value of transcutaneous oxygen tension (tcPO2) as an oxygen parameter during uncomplicated thoracic anaesthesia was examined in ten patients anaesthetized with oxygen-nitrous oxide and enflurane or flunitrazepam/fentanyl. tcPO2 was measured with the Radiometer TCM-I monitor at 45 degrees C. Measuring interference due to the anaesthetic agents was not observed. tcPO2 was found to be lower than the arterial tension (PaO2) at any inspiratory oxygen fraction (FIO2). When the peroperative readings were related to the preoperative values, no statistically significant difference was found between PaO2 and tcPO2 at FIO2 - 0.5, 0.4 and 0.3 (P greater than 0.3). ⋯ This disparity indicates a decrease in the tcPO2/PaO2 ratio with increasing PaO2. It is concluded that tcPO2 cannot substitute for PaO2, but tcPO2 and PaO2 proved to be equally useful as oxygen parameters in the examined patients. Interpretation of tcPO2 during anaesthesia, however, necessitates a preoperative measurement as reference.
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Acta Anaesthesiol Scand · Dec 1980
Comparative Study Clinical TrialDouble-blind, multiple-dose comparison of buprenorphine and morphine in postoperative pain.
The analgesic profile and side-effects of buprenorphine 0.3 mg and morphine 10 mg intramuscularly were compared postoperatively in a double-blind, non-crossover, multiple-dose study. When the patient complained of moderate to severe postoperative pain after halothane-relaxant anesthesia for upper abdominal surgery, the first test dose of either drug was given. Subsequent similar doses of buprenorphine 0.3 mg or morphine 10 mg were given when required (maximum ten doses). ⋯ Other effects of the two drugs on vital signs were similar. The incidence of other side-effects was fairly similar after both analgesics. The patients' subjective appraisal favoured buprenorphine.