Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 1984
Randomized Controlled Trial Comparative Study Clinical TrialFailure of epidural analgesia to modify postoperative depression of delayed hypersensitivity.
Delayed hypersensitivity to four common antigens was assessed in 32 patients undergoing major abdominal surgery randomly allocated to either general anesthesia (fentanyl + O2/N2O + postoperative pain relief with systemic opiates) or general anaesthesia + epidural analgesia (local anaesthetics + morphine) continued for 72 h. Skin-test responses were performed 2 days before surgery and 1 day after surgery and compared to a similar retesting schedule in 16 comparable non-operative control patients. ⋯ In contrast, mean skin-test responses in patients operated during general anaesthesia + systemic opiates for postoperative pain relief fell from 1422 to 1227 mm2 (P = 0.3) and in patients receiving epidural analgesia from 1228 to 890 mm2 (P = 0.06), without statistically significant differences between these two groups (P greater than 0.5). Thus, surgery leads to depression of delayed hypersensitivity and this impairment in immunofunction is not modified by an epidural analgesic regimen providing adequate pain relief.
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Acta Anaesthesiol Scand · Apr 1983
Randomized Controlled Trial Clinical TrialPerivascular axillary block II: influence of injected volume of local anaesthetic on neural blockade.
Perivascular axillary blockade was performed on 150 patients with the aid of a catheter technique. Blockade failure due to injection outside the neurovascular sheath was found in 5.7% of the subject material. The patients were randomly allocated to three groups. ⋯ Sensory and motor blockade was tested 30 min after each injection. The following results were obtained: 1) Apart from the axillary, musculocutaneous and radial nerves, a high frequency of analgesia was found in all cutaneous areas (over 85%). 2) In the axillary area, improvements were found with increasing volume. 3) Analgesia in the musculocutaneous area occurred in 52% of the patients in group 1 (20 ml) and improved to 75% in group 2 (40 ml). However, no difference was found between group 2 and group 3 (80 ml). 4) Volume had no influence on analgesia in the radial area. 5) Motor blockade was intensified with decreasing volume, i.e. with an increase of concentration of local anaesthetic solution.
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Acta Anaesthesiol Scand · Apr 1983
Randomized Controlled Trial Clinical TrialLidocaine given intravenously as a suppressant of cough and laryngospasm in connection with extubation after tonsillectomy.
The preventive effect of lidocaine against coughing in the recovery period after general anaesthesia was observed. The study was carried out as a double-blind sequential trial. At the same time the incidence of laryngospasm was registered. ⋯ Nineteen patients for tonsillectomy, all of them over the age of 15, randomly received a 2% solution of lidocaine 2 mg/kg body weight or placebo (saline) 2 min prior to expected extubation. We found that lidocaine in this dose given prophylactically just before extubation was able to inhibit and prevent coughing in the recovery period after general anaesthesia. None of the patients included in this study got laryngospasm, and none of the patients developed serious side-effects.
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Acta Anaesthesiol Scand · Dec 1982
Case Reports Randomized Controlled Trial Clinical Trialbeta-Receptor blockade and neurolept anaesthesia. Withdrawal vs continuation of long-term therapy in gall-bladder and carotid artery surgery.
Forty-eight chronically (greater than 3 months) beta-receptor-blocked patients with ischaemic heart disease and/or hypertension were studied on 49 occasions after random distribution to a 4-day, gradual preoperative withdrawal (n = 26) or a continuation (n = 23) of beta-receptor blockers. The patients were scheduled for either a cholecystectomy (n = 28) or a carotid thrombendarterectomy (n = 21) under neurolept anaesthesia. Three patients were excluded from the randomized part of the study due to complications (tachycardia, hypertension, severe angina) after therapy withdrawal. ⋯ Significantly more postoperative ECG changes (P less than 0.02) indicative of myocardial ischaemia were found than in beta-receptor blocked patients. These patients had low heart rates but also pronounced increases in pulmonary capillary wedge pressures, which in single patients could be associated with myocardial damage. These results imply that beta-receptor blockers should be continued before surgery and that a concomitant vasodilatatory therapy is likely to avoid the drawbacks of an increased cardiac afterload.
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Acta Anaesthesiol Scand · Oct 1982
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia and lung function: a comparison of intramuscular with epidural morphine.
Thirty healthy patients subjected to cholecystectomy or operation for duodenal ulcer were allocated randomly for postoperative analgesic treatment with morphine i.m. or epidurally. Morphine was given only at the request of the patients and only as much was given as was needed to obtain satisfactory pain relief. ⋯ Compared with the i.m. group, there was a higher arterial oxygen tension and a slower increase in alveolar-arterial oxygen difference. It is concluded that epidural morphine analgesia reduces the degree of postoperative lung dysfunction compared with conventional i.m. morphine treatment.