British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Continuous intercostal blockade after cardiac surgery.
The provision of analgesia using continuous bilateral intercostal blockade was compared with that provided by conventional i.v. narcotics for the first 48 h after cardiac surgery. The subjective quality of analgesia was significantly superior with the regional technique. However, pulmonary function tests, gas exchange, lung volume, and radiological and clinical evidence of pulmonary complications were not improved. The failure to reduce morbidity and the potential for complications such as pneumothorax, makes it difficult to recommend the regional analgesia technique in this situation.
-
The arterial to end-tidal PCO2 difference (PaCO2-PE'CO2) was measured in five anaesthetized dogs during controlled ventilation at 0.25 Hz (15 b.p.m.) and during high frequency jet ventilation at 1, 3 and 5 Hz. Because of the slow response of the infra-red carbon dioxide analyser, satisfactory recordings of end-tidal carbon dioxide could not be obtained at frequencies greater than 1 Hz. The interruption of high frequency jet ventilation by conventional ventilation resulted in approximately equal arterial and end-tidal PCO2 values during the first breath, and restoration of the normal arterial to end-tidal PCO2 difference by the third breath. It is concluded that, when high frequency jet ventilation at 1, 3 or 5 Hz is interrupted with normal tidal volumes at low frequencies, the arterial PCO2 can be estimated from recordings of the end-tidal PCO2.
-
Five patients who underwent thoracic operations had an extradural catheter placed in the paravertebral space. X-ray contrast was injected through the catheters. ⋯ In one patient, contrast appears to have entered the extradural space and, in another who had no detectable analgesia, the contrast was probably dispersed intrapleurally. The significance of these findings is discussed.
-
Complications of local anaesthesia in general have been considered in so far as they may be confused with adverse effects of local anaesthetic drugs. Local anaesthetics may give rise to adverse reactions by a number of mechanisms. They affect nerve conduction and vasculature at the site of injection: a local effect; but is it unlikely that they ever produce an irreversible noxious effect on nerve fibres. ⋯ Ignorance or carelessness are frequently causative factors in serious reactions. Adequate oxygenation is vital in prophylaxis and immediate treatment of systemic toxicity, while resuscitative skill and equipment must always be to hand. Idiosyncrasy or allergy can only rarely be an excuse for adverse reactions to local anaesthesia.
-
Opioids were available in clinical practice since before the birth of modern anaesthesia--Setürner isolated morphine in 1806. They have a record of safety which is reflected in their high therapeutic ratios, especially the synthetic opioids introduced recently (table III). The most serious immediate adverse effect, respiratory depression, is a predictable effect related closely to analgesia. It is fortunate for anaesthetists who use opioids regularly, that recognition and treatment of respiratory problems are an integral part of their craft and that opioid antagonists are effective in reversing respiratory depression.