Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 1999
Randomized Controlled Trial Clinical TrialTopical wound anaesthesia in children--a temporary postoperative pain relief.
Administration of local anaesthetics into the surgical wound may modulate pain at the peripheral level. A previous study in adults has shown good analgesic effects of topical lidocaine in wounds after herniorrhaphy. ⋯ A very short and clinically insignificant pain relief is obtained following the administration of a lidocaine aerosol in the surgical wound. A low pain level in this model may limit the possibility to detect an effect of lidocaine.
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Acta Anaesthesiol Scand · Feb 1999
Randomized Controlled Trial Clinical TrialThe effect of ketamine on clinical endpoints of hypnosis and EEG variables during propofol infusion.
We studied the effect of variable doses of ketamine on the endpoints of hypnosis, e.g., unresponsiveness to verbal commands (UVC), loss of eyelash reflex (LER), and inhibition of body movement response with or without sneezing to nasal membrane stimulation (INBMR), and processed EEG variables, e.g., bispectral index (BIS), 95% spectral edge frequency (SEF) and median frequency (MF) during propofol infusion. ⋯ Our results suggest additive interaction between propofol and ketamine (Groups PK0.5 and PK0.75) for achieving the hypnotic endpoints; however, ketamine did not depress the EEG variables in proportion to its hypnotic effect. The paradoxically higher BIS and 95% SEF values at the hypnotic endpoints may be due to lower propofol concentrations and/or no effect of ketamine on the EEG variables.
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Acta Anaesthesiol Scand · Feb 1999
Clinical TrialPerioperative ST-segment depression and troponin T release. Identification of patients with highest risk for myocardial damage.
Patients undergoing major vascular surgery are at constant risk of developing perioperative myocardial complications, especially myocardial infarction. The following study was performed to answer the question whether ST segment changes, analysed by Holter monitoring and ST segment analysis, are accompanied by release of cardiac troponin T, a highly specific marker of myocardial damage. ⋯ Haemodynamic changes, oxygen imbalance and stress during major vascular surgery frequently lead to an ischaemic burden, which is indicated by ST segment changes during ECG ST analysis. Longlasting ST depression reaching an individual critical cut-off limit followed by structural myocardial damage may be verified by elevated levels of cardiac troponin T. Prolonged periods of ST depression should be followed by determination of cardiac troponin T.
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Acta Anaesthesiol Scand · Feb 1999
Attitudes of Swedish physicians and nurses towards the use of life-sustaining treatment.
Withdrawal or withholding of life-sustaining treatment have become accepted clinical practice within the intensive care unit (ICU). One important factor influencing these decisions is the attitudes of physicians and nurses. ⋯ Advance directives are believed by Swedish intensive care personnel to be very important in the decision to withdraw life support, contrary to several descriptive studies suggesting modest patient and family influence on these decisions. Attitudes towards the intensity of care vary between different centers, raising the possibility that levels of care for similar patients may differ across the country.
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Acta Anaesthesiol Scand · Feb 1999
Neuroprotective properties of propofol and midazolam, but not pentobarbital, on neuronal damage induced by forebrain ischemia, based on the GABAA receptors.
The mechanism of the neuroprotective effects of propofol was compared to two other types of intravenous (i.v.) anesthetics (i.e., benzodiazepine; midazolam and barbiturate; pentobarbital) using Mongolian gerbils focusing on GABA receptor subtypes. ⋯ These results indicate that activation of GABAA receptors, which include the specific binding subunits for propofol and midazolam, but not pentobarbital, plays a role in the inhibition of neuronal death induced by brain ischemia.