Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 1999
Case ReportsPercutaneous dilatational tracheostomy in a patient with thyroid cancer and severe airway obstruction.
A patient with extensive metastatic thyroid cancer scheduled for palliative tracheostomy is presented. He had laryngeal dislocation with severe airway obstruction and few anatomical landmarks due to tumour infiltration and radiation. Successful percutaneous dilatational tracheostomy was performed under local anaesthesia.
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Acta Anaesthesiol Scand · Apr 1999
Comparative StudyMetabolic regulation of cardiac output during inhalation anaesthesia in dogs.
The metabolic regulation of tissue blood flow manifests itself in a linear relation between blood flow and oxygen consumption, the latter being the independent variable. It is unknown, however, if this fundamental physiological principle operates also during inhalation anaesthesia known to be associated with decreases in both cardiac output (Q) and oxygen consumption (VO2). ⋯ Inhalation anaesthesia is characterized by a uniform Q/VO2 relation with an almost linear course at an anaesthetic concentration up to 2 MAC, regardless of the anaesthetic. Metabolic regulation of blood flow apparently operates also during inhalation anaesthesia up to 2 MAC so that the decrease in VO2 determines Q. This implies that cardiac output alone provides little information on the function of the circulation during inhalation anaesthesia unless related to metabolic demands, i.e. to VO2.
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Acta Anaesthesiol Scand · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialFocus on mobilisation after lower abdominal surgery. A double-blind randomised comparison of epidural bupivacaine with morphine vs. lidocaine with morphine for postoperative analgesia.
Epidural infusion of morphine, usually with bupivacaine, for postoperative pain relief has proved to be safe and effective. Lidocaine with its short duration of action and low toxicity may be an alternative to bupivacaine. The clinical importance of the choice of local anaesthetic drug on mobilisation after lower abdominal surgery has not been studied previously. ⋯ There were no clinically or statistically significant differences in the postoperative course after lower abdominal surgery in patients who received an epidural infusion of morphine combined with bupivacaine as compared to patients who received morphine with lidocaine. Further clinical studies to establish the place of lidocaine in postoperative epidural analgesia should be performed.
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Acta Anaesthesiol Scand · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialComparison of transarterial and multiple nerve stimulation techniques for axillary block using a high dose of mepivacaine with adrenaline.
High-dose transarterial (TA) technique results in high effectiveness of the axillary block. The technique is fast and simple, but does not produce a satisfactory success rate when using the manufacturer's recommended dose of mepivacaine. The multiple nerve stimulation (MNS) technique requires more time and experience. This double-blind study compared effectiveness, safety and the time used to obtain an effective analgesia in 101 patients, having an axillary block by either TA or MNS techniques. ⋯ The MNS technique of axillary block by four injections of 10 mL of 2% MEPA produces faster and more extensive block than the TA technique by two injections of 20 mL. Therefore, the MNS technique requires fewer supplementary blocks and results in faster patient readiness for surgery. However, high doses of MEPA may result in dangerous systemic toxic reactions.
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Acta Anaesthesiol Scand · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialIrrigation fluid absorption during transurethral resection of the prostate: spinal vs. general anaesthesia.
The absorption of irrigation fluid during transurethral resection of the prostate (TURP) is determined primarily by hydrostatic pressure in the bladder and prostatic venous pressure. In comparison to spontaneously breathing patients, patients undergoing mechanical ventilation with positive pressure have a raised central venous pressure and a reduced venous return, both of which can influence intravascular absorption. The purpose of the prospective study was to compare the effects of general (GA) and spinal anaesthetic (SA) techniques on the perioperative absorption of irrigating fluid in patients undergoing TURP. ⋯ The absorption of irrigation fluid during the TURP is significantly more marked amongst spontaneously breathing patients with regional anaesthesia in comparison to patients undergoing general anaesthesia with positive pressure ventilation. The markedly lower central venous pressure before the start of irrigation should be considered as a possible cause of this effect.