Annales chirurgiae et gynaecologiae
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The clinically useful local anesthetic agents can be divided chemically into the amino-esters, e.g., procaine, chloroprocaine and tetracaine, and the amino-amides, e.g., lidocaine, mepivacaine, prilocaine, bupivacaine and etidocaine. Pharmacologically, these agents can be categorized as agents of low potency and short duration of action, e.g., procaine and chloroprocaine; agents of intermediate potency and duration of action, e.g., lidocaine, mepivacaine and prilocaine; and agents of high potency and long duration, e.g., tetracaine, bupivacaine and etidocaine. The blood level of local anesthetics is determined by the rate of uptake, tissue redistribution, metabolism and excretion. ⋯ Among the ester agents chloroprocaine is cleared most rapidly due to its fast rate of hydrolysis. Within the amide series, prilocaine is cleared most rapidly due to its fast rate of tissue redistribution and its rapid hepatic metabolism. Bupivacaine is cleared most slowly due primarily to its decreased rate of hepatic degradation.
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Case Reports Comparative Study
Anaesthesia for patients with multiple sclerosis.
The types of anaesthesia administered to 56 multiple sclerosis patients undergoing surgery in the different departments of the Helsinki University Central Hospital (HUCH) during a ten year period from 1973 to 1982 were studied. The perioperative and postoperative events were analyzed in relation to the method of anaesthesia. ⋯ In four patients who were given regional anaesthesia (2 spinal, 3 epidural) marked by hypotension, quite resistant to intravenous vasopressor treatment was observed. No deterioration of the multiple sclerosis was noted postoperatively which could be related to the anaesthesia.
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Sufficient placental blood flow is mandatory for the well-being of the fetus. The delicate balance between uterine perfusion pressure and uterine vascular resistance can be critically disturbed during epidural anaesthesia. Maternal hypotension is common when extensive block for Caesarean Section is used. ⋯ Epinephrine (less than or equal to 50 micrograms), added to the local anaesthetic, will not decrease IBF. IBF can be severely reduced in pregnancy-induced hypertension (PIH) since the fetus is chronically asphyxiated it is crucial to avoid any further decrease in IBF. Extensive sympathetic blockade (T8) using epidural analgesia (10 ml dose of 1.a.) has been shown to significantly (p less than 0.01) improve IBF in parturients with PIH by decreasing uteroplacental vascular resistance.
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The most important complications following gastrointestinal surgery are related to disruption of anastomoses. The fate of a gastrointestinal anastomosis is influenced by many factors. Among these, care in the anaesthetic management and postoperative treatment may reduce the incidence of complications. ⋯ The prevention of high intra-luminal pressures and excessive longitudinal traction across anastomoses may be aided by care in the administration of neostigmine, and possibly by the avoidance of morphine for provision of intra-operative and postoperative analgesia. Maintenance of, or improvements in, oxygen supply to an anastomosis may be achieved by avoiding hypoxia, hypocapnia and hypovolaemia, and by the use of regional anaesthetic techniques during surgery and/or in the post-operative period. In addition, sedative and analgesic therapy may influence the incidence of postoperative ileus, and may thus contribute to morbidity.