Articles: surgery.
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Journal of anesthesia · Mar 1996
Does increasing end-tidal carbon dioxide during laparoscopic cholecystectomy matter?
To examine the adverse effects of peritoneal carbon dioxide (CO2) insufflation during laparoscopic cholecystectomy, both hemodynamic and respiratory alterations were continously monitored in 17 adult patients using noninvasive Doppler ultrasonography and a continuous spirometric monitoring device. During the surgery, which was performed under inhalational general anesthesia, intraabdominal pressure was maintained automatically at 10mmHg by a CO2 insufflator, and a constant minute ventilation, initially set to 30-33 mmHg of end-tidal CO2 (ETCO2), was maintained. ⋯ The stress of 10mmHg pneumoperitoneum was a major cause of hemodynamic changes during laparoscopic cholecystectomy. Some clinical strategies such as deliberate intraabdominal insufflation at the initial phase might be required to minimize these hemodynamic changes.
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We compared the effects of normothermic cardiopulmonary bypass (CPB) with those of hypothermic CPB in patients who underwent coronary artery bypass grafting (CABG) with respect to hemodynamics and oxygen balance. The patients in our study were divided into two groups according to temperature during CPB: systemic normothermia combined with warm blood cardioplegia (group W,n=36) and systemic hypothermia combined with cold crystalloid cardioplegia (group C,n=26). In group W, the use of directcurrent (DC) defibrillators was less frequent after release of the cross clamp, and the duration of CPB and of reperfusion was shorter. ⋯ Mixed venous oxygen saturation ([Formula: see text]) was maintained above 65% during and after CPB in group W and group C. Our results showed that normothermia may be superior to hypothermia during CPB with respect to recovery of cardiac function and avoidance of hyperglycemia. The whole-body oxygen demand-supply balance may be preserved during normothermic as well as hypothermic CPB.
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Journal of anesthesia · Mar 1996
Epidural anesthesia during upper abdominal surgery provides better postoperative analgesia.
Since repeated noxious stimuli may sensitize neuropathic pain receptors of the spinal cord, we tested the hypothesis that the appropriate blockade of surgical stimuli with epidural anesthesia during upper abdominal surgery would be beneficial for postoperative analgesia. Thirty-six adult patients undergoing either elective gastrectomy or open cholecystectomy were randomly allocated to receive either inhalational general anesthesia alone (group G) or epidural anesthesia along with light general anesthesia (group E) throughout the surgery. ⋯ While there was no significant difference in the bupivacaine dose, more patients undergoing gastrectomy in group G required supplemental analgesics than those in group E, and the VAS scores in group E demonstrated significantly better postoperative analgesia compared to group G after both types of surgery. Thus, an appropriate epidural blockade during upper abdominal surgery likely provides better postoperative pain relief.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous ketorolac vs diclofenac for analgesia after maxillofacial surgery.
To compare the efficacy of the non-steroidal antiinflammatory drugs (NSAID), ketorolac and diclofenac in prevention of pain after maxillofacial surgery. ⋯ Parenteral ketorolac (0.4 mg.kg-1 four times in 24 hr) and diclofenac (1 mg.kg-1 twice in 24 hr) were similar, but insufficient alone, for analgesia after maxillofacial surgery.
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Journal of anesthesia · Mar 1996
Prophylactic epidural administration of fentanyl for the suppression of tourniquet pain.
Severe dull pain on the side of tourniquet application and marked rises in blood pressure and heart rate associated with that pain are often observed even under adequate regional analgesia. The purpose of this study was to evaluate the effect of epidural fentanyl on the suppression of tourniquet pain during orthopedic surgical procedures. Forty-five patients undergoing orthopedic surgery of the lower extremities with a tourniquet were maintained by continuous epidural anesthesia with 2% lidocaine through an epidural indwelling polyethylene catheter (L3-4). ⋯ Blood pressure during tourniquet application in the epidural group was more stable than in the other two groups. No severe side-effects were observed in any patient. Prophylactic epidural administration of fentanyl might be useful in the suppression of tourniquet pain.