Articles: anesthesia.
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Ugeskrift for laeger · Jan 1987
Randomized Controlled Trial Comparative Study Clinical Trial[Patients' experience in epidural anesthesia and general anesthesia].
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response.
In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and d-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 micrograms/kg intravenously) to the anaesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, and 11-deoxycortisol levels, in the insulin/glucagon, molar ratio, and in blood glucose, lactate, and pyruvate concentrations were significantly greater in the non-fentanyl than in the fentanyl group. ⋯ Compared with the fentanyl group, the non-fentanyl group had circulatory and metabolic complications postoperatively. The findings indicate that preterm babies mount a substantial stress response to surgery under anaesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anaesthesia may be associated with an improved postoperative outcome.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia.
To investigate whether or not injection of local anesthetic into the fracture hematoma on reduction of a Colles' fracture increases the risk of neurological complications, a prospective randomized trial was conducted. The outcome in 62 patients whose Colles' fractures were reduced in a new bone-alignment device without anesthesia was compared with that in 54 patients with Colles' fractures that were reduced manually after injection of local anesthetic. At follow-up, any symptoms and signs of nerve damage were recorded. ⋯ The difference is significant (p less than 0.01). The authors have previously shown that injection of local anesthetic into the hematoma of Colles' fractures increases the carpal tunnel pressure. Neurological complications after the use of local anesthesia in reducing Colles' fractures is considered to be secondary to the scarring and fibrosis caused by this increase in pressure.
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Randomized Controlled Trial Clinical Trial
Minor complications following anaesthesia in young adults for orthopaedic surgery of the lower extremity.
In all, 175 young (15-40 yr) patients received either spinal anaesthesia with bupivacaine (104 patients) or general, balanced anaesthesia (71 patients) for orthopaedic surgery of the lower extremities. Each patient was interviewed before the operation, problems that arose during the operation were recorded and all patients were interviewed on the first postoperative day. One hundred and seven patients were interviewed after being discharged, 1-3 months after the operation. ⋯ All these problems had ceased at the interview 1-3 months later. Eight (six spinal and two general anaesthesia patients) were not satisfied with the method of anaesthesia used. This study revealed that an appreciable number of young patients have complications after anaesthesia, but the complications are minor and self-limited.
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Randomized Controlled Trial Clinical Trial
The effect of thoracic epidural analgesia on postoperative stress and morbidity.
A hundred patients scheduled for cholecystectomy were randomized to either thoracic epidural anaesthesia and analgesia for 24 h with bupivacaine intraoperatively about 100 mg and 15 mg/h thereafter (TEA) for postoperative analgesia, TEA combined with general anaesthesia (low dose fentanyl) (TEA + GA) and general anaesthesia (GA) (low dose fentanyl). During TEA and TEA + GA the arterial pressure was significantly decreased as compared with GA. TEA was associated by an intense haemodilution in comparison with GA. ⋯ The postoperative alleviation of the alteration of the above mentioned parameters by TEA was slightly diminished in the TEA + GA group. However, we found no significant reduction in cardiac dysrhythmias (TEA 7%, TEA + GA 7% and GA 10%), ST-segment depression (TEA 17%), TEA + GA 3.3% and GA 12.5%), wound complication (TEA 3%, TEA + GA 0%, GA 0%), pneumonia (TEA 3%, TEA + GA 3% and GA 0%), subphrenic abscess (TEA 6%, TEA + GA 0%, GA 3%), mortality (TEA 0%, TEA + GA 3%, GA 0%), and urinary tract infect (TEA 17%, TEA + GA 7% and GA 2.5%). Since an equal number of patients in each group, about 30%, suffered one or more of the postoperative complications this epidural analgesia was not effective in reducing postoperative morbidity albeit the significant alleviation of the postoperative stress response.