Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 1997
Postoperative epidural infusion of morphine and bupivacaine is safe on surgical wards. Organisation of the treatment, effects and side-effects in 2000 consecutive patients.
There was an obvious need to improve the quality and safety of our postoperative pain treatment and to introduce an improved routine service on surgical wards. ⋯ Our experience with this postoperative epidural analgesia regime is favourable. It has been easy to administer and monitor. Pain relief was excellent, side-effects were few and picked up by the established routines followed by the ward staff except in the 2 trauma patients who developed epidural abscesses. The staff on the surgical wards were motivated for this kind of work. Education and strict surveillance routines are mandatory in order to secure prompt action when warning signs develops (e.g. lower limb paralysis).
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Acta Anaesthesiol Scand · Aug 1997
Weight gain during pregnancy does not influence the spread of spinal analgesia in the term parturient.
It is still controversial whether the spread of spinal anaesthesia in pregnancy is influenced by particular physique. Investigation was based on a clinical observation that parturients with a pronounced "pregnant" physique, e.g. generalised oedema and heavy abdomen, tended to develop more cephalad sensory blockades than parturients without these physical signs. Using weight gain during pregnancy as a measure for the physique at term, we aimed to determine whether this parameter influences the distribution of analgesia after subarachnoidal injection of plain bupivacaine. ⋯ In parturients, weight gain during pregnancy, height, weight and body-mass index did not influence the extent of sensory analgesia after subarachnoidal administration of plain bupivacaine.
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Acta Anaesthesiol Scand · Aug 1997
Pharmacodynamic modelling of the analgesic effects of piritramide in postoperative patients.
The concentration-effect relationship of piritramide, a synthetic opioid analgesic predominantly used for postoperative analgesia and analgosedation, has not been reported so far. ⋯ The analgesic effect of piritramide was adequately described by an inhibitory fractional Emax-model. In order to overcome the pronounced hysteresis, piritramide should initially be administered as an intravenous bolus of at least 5 mg.
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Acta Anaesthesiol Scand · Aug 1997
Calculated versus measured oxygen consumption during and after cardiac surgery. Is it possible to estimate lung oxygen consumption?
Lung tissue is metabolically active and consumes oxygen. The oxygen content difference between arterial and mixed venous blood does not include the effect of pulmonary tissue oxygen uptake. Thus, oxygen consumption (VO2) of the lung should be reflected as a difference between VO2 measured by gas exchange and VO2 derived by the Fick principle. The purpose of this study was to measure in clinical conditions this difference (taken to represent the VO2 of the lung), and to evaluate the sources of error in lung VO2 estimation. ⋯ A constant difference between measured and calculated VO2 can be detected in carefully controlled clinical conditions. The difference between the two methods is due to both lung oxygen consumption and errors in the measurement of VO2 thermodilution cardiac output, haemoglobin and blood oxygen contents. We suggest that the perioperative changes of the VO2-difference are due not only to variation of the measurements but also to changes in lung metabolic activity.
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Acta Anaesthesiol Scand · Aug 1997
Continuous low-flow tracheal gas insufflation during partial liquid ventilation in rabbits.
Both partial liquid ventilation (PLV) and tracheal gas insufflation are novel techniques for mechanical ventilation. In this study we examined whether PLV superimposed by continuous low-flow tracheal gas insufflation (TGI) offers any advantage to the blood gases and lung mechanics in normal-lung rabbits compared to the use of PLV only. ⋯ In summary, continuous low-flow TGI superimposed on PLV can decrease and stabilize the PaCO2 elevation caused by the initiation of PLV.