Anestezjologia intensywna terapia
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Postoperative analgesia should be adjusted to current needs of a patient. Non-opioid agents are recommended, wherever possible: both non-steroidal anti-inflammatory drugs (NSAIDs), metamizole or paracetamol may be useful for treatment of acute pain. The use of metamizole is associated with such complications as bone marrow damage (agranulocytosis, aplastic anaemia), chronic interstitial nephritis, gastro-intestinal disturbances, etc. ⋯ Modern multimodal analgesia should be based on a good combination of analgesics. Both metamizole and paracetamol may be used for such a purpose, yet in the lowest effective doses, within the shortest needed time and once evident contraindications have been considered. Safety of both drugs is several times higher than that of commonly used NSAIDs.
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A substantial component of the pain experienced by patients after abdominal surgery is derived from the abdominal wall incision. The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. The block has been described by McDonnell and colleagues, and can be used for intra and postoperative analgesia in patients having surgery in the lower abdominal region, especially for caesarean section, inguinal hernia repair and laparoscopy. The technique of blind and ultrasound-controlled blockade is described and discussed in detail.
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Anestezjol Intens Ter · Apr 2009
Randomized Controlled Trial Comparative Study[Rocuronium vs atracurium vs suxamethonium for double-lumen endobronchial tube intubation].
Intubation with a double lumen tube requires excellent and stable relaxation, necessary for accurate positioning of the device using a fibre optic scope. ⋯ Although all drugs given in equipotent doses proved to be suitable for the planned procedure, we conclude that suxamethonium could easily be abandoned in routine anaesthesia for elective lung surgery.
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Anestezjol Intens Ter · Apr 2009
Randomized Controlled Trial Comparative Study[Paravertebral block for open cholecystectomy].
Open cholecystectomy is usually performed under general anaesthesia; the use of regional techniques is limited to those patients in whom general anaesthesia poses a certain risk and should be avoided. Among other techniques, paravertebral block can be used for perioperative analgesia. We evaluated the efficacy of thoracic paravertebral block (TPVB) for this purpose. ⋯ General anaesthesia with unilateral thoracic paravertebral block provides satisfactory conditions for open cholecystectomy. TPVB significantly improved the quality of postoperative analgesia, reduced the frequency of PONV, and increased the comfort of patients.