RESUMO
Continuous spinal anaesthesia technique can be associated with peridural haemorrhage due to blood vessel damage caused by the needle or the catheter. We studied whether thrombosis prophylaxis or anticoagulation medications increase the risk of subarachnoid haemorrhage when continuous spinal anaesthesia is used. Twenty arthroplasty patients received low-molecular-weight heparin preoperatively and twenty-two vascular surgery patients received heparin (100 IU kg-1) peroperatively; eight of the latter patients were on regular preoperative antiplatelet medication. Twenty-four prostate surgery patients, not exposed to heparin or other drugs affecting coagulation, served as controls. A 22-gauge spinal catheter was used and bupivacaine was injected through the catheter. Within the following 24 hours, 4-5 cerebrospinal fluid samples were collected for erythrocyte counts. In the arthroplasty and the vascular group there were five patients each and in the control group seven patients with more than 100 x 10(6) l-1 erythrocytes in at least one of the samples. The highest erythrocyte count was 23900 x 10(6) l-1 in a control patient. The 24-hour sample was blood-tinged (erythrocytes > 1000 x 10(6) l-1) in two patients in the arthroplasty group, in one patient in the vascular group and in four patients in the control group. In spite of the haemorrhages detected in this study, no related neurological symptoms or other serious consequences were observed. The risk of subarachnoid haemorrhage was not increased by drugs affecting coagulation.
Assuntos
Raquianestesia/efeitos adversos , Líquido Cefalorraquidiano/citologia , Hemorragia Subaracnóidea/etiologia , Idoso , Contagem de Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1-2 patients undergoing elective laparoscopic cholecystectomy. The patients were randomly selected (20 patients in each group) to receive in double-blind fashion 100 mo of either plain 0.15% bupivacaine (150 mg.100 ml-1) or the same solution with adrenaline (1.5 micrograms ml-1), or the same volume of saline into the right subdiaphragmatic space at the end of surgery. The patients were kept in the Trendelenburg's position for 20 min after the instillation. Venous blood samples for the determination of bupivacaine plasma concentrations were drawn up to 180 min. Plasma bupivacaine concentrations peaked at 30 min (highest individual value 2.6 micrograms ml-1) after instillation. Bupivacaine concentrations were significantly lower in the bupivacaine-adrenaline group. During the follow-up no difference between the groups occurred as to the time to first demand of analgesia, severity of postoperative pain, amount of consumed analgesics during 7 days, and length of hospitalization. In all groups, 30-45% of the patients complained of right shoulder pain. After the first 24 hours, pain at rest and during moving was reported as mild and was managed with oral ketoprofen. It is concluded that postsurgical intraperitoneal instillation of 150 mg bupivacaine in 100 ml of saline had no effect on pain after laparoscopic cholecystectomy.
Assuntos
Analgesia , Bupivacaína/administração & dosagem , Colecistectomia Laparoscópica , Dor Pós-Operatória/prevenção & controle , Dor Abdominal/prevenção & controle , Administração Oral , Bupivacaína/sangue , Colecistectomia Laparoscópica/efeitos adversos , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Epinefrina/administração & dosagem , Feminino , Seguimentos , Humanos , Injeções Intraperitoneais , Cetoprofeno/administração & dosagem , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Oxicodona/administração & dosagem , Ombro , Fatores de TempoRESUMO
The effects of the new, highly selective alpha 2-adrenergic agonist, dexmedetomidine, were studied in a randomized, placebo-controlled, double-blind trial in 24 ASA I patients. Dexmedetomidine 0.6 micrograms kg-1 or saline was given i.v. 10 min before induction of anaesthesia. The required dose of thiopentone was significantly (P less than 0.001) smaller in the dexmedetomidine group (mean 4.4 (sd 0.9) mg kg-1) than in the control group (6.9 (1.6) mg kg-1), and the drug attenuated the cardiovascular responses to laryngoscopy and tracheal intubation. The concentration of noradrenaline in mixed venous plasma was smaller in the dexmedetomidine group during all phases of induction (P less than 0.01). During surgery, fentanyl was required in a dose of 0.5 (0.6) mg kg-1 and 2.8 (2.6) mg kg-1 in the dexmedetomidine and control groups, respectively (P less than 0.001). During 2 h postoperative follow-up, oxycodone 0.06 (0.06) mg kg-1 and 0.16 (0.1) mg kg-1 (P less than 0.05) was given to the two groups respectively.
Assuntos
Agonistas alfa-Adrenérgicos/farmacologia , Hemodinâmica/efeitos dos fármacos , Imidazóis/farmacologia , Intubação Intratraqueal , Medicação Pré-Anestésica , Adulto , Período de Recuperação da Anestesia , Anestesia Geral , Método Duplo-Cego , Epinefrina/sangue , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Medetomidina , Pessoa de Meia-Idade , Norepinefrina/sangue , Tiopental/administração & dosagemRESUMO
We have studied the effect of verapamil on the incidence of ECG changes and right ventricular pressures (RVP) in 25 male patients (aged 62 (SD 9) yr) undergoing thoracotomy in a placebo-controlled double-blind trial. Verapamil 0.01 mg kg-1 h-1 (n = 12) or saline (n = 13) i.v. was started after surgery and continued on the first day after operation with oral verapamil 80 mg or placebo, 8-hourly. Haemodynamic data were collected before operation and on three days after operation with the patients breathing air and then 60% oxygen (FIO2 0.60) for 10 min. Atrial tachyarrhythmia (AT) (4/13) and new ischaemic ECG changes (3/13) occurred only in the control group (P less than 0.05). With an FI02 of 0.21, systolic RVP increased by 54% on the first two days after operation in the control group and by 13% in the verapamil group (P less than 0.02). With an FIO2 of 0.60 for 10 min, systolic RVP decreased more in the control than in the verapamil group (P less than 0.01). In the control group, an increase in end-diastolic RVP (P less than 0.001) and central venous pressure (P less than 0.05) on the first day after operation was predictive of AT occurring on the second day.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Complicações Pós-Operatórias/prevenção & controle , Taquicardia Atrial Ectópica/prevenção & controle , Toracotomia , Função Ventricular Direita/efeitos dos fármacos , Verapamil/uso terapêutico , Administração Oral , Idoso , Pressão Sanguínea/fisiologia , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Função Ventricular Direita/fisiologia , Verapamil/administração & dosagemRESUMO
Forty patients scheduled for elective colonic surgery were allocated at random to receive either nitrous oxide or air during surgery. Preoperative management, surgery, parenteral therapy and postoperative analgesics were similar in both groups. Anaesthetic management included isoflurane, vecuronium by infusion and fentanyl 3 micrograms kg-1 h-1. The air group required a mean inspired isoflurane concentration of 0.8% (SD 0.3), whereas the nitrous oxide group required 0.4% (SD 0.2). No differences were found in duration of operation, blood loss, need for postoperative analgesia or postoperative nausea. Patients in the air group had less gas in the small bowel (P less than 0.005) and in the large bowel (P less than 0.001), and operating conditions were better than in the nitrous oxide group (P less than 0.01). After operation, the air group had significantly earlier bowel function than the nitrous oxide group, with earlier passing of flatus (3.4 (1.2) vs 4.7 (1.4) days) (P less than 0.05) and faeces (4.7 (1.5) vs 6.3 (2.2) days) (P less than 0.05) and required a shorter postoperative hospital stay (10.0 (1.3) vs 11.7 (2.5) days) (P less than 0.05).
Assuntos
Anestesia por Inalação/efeitos adversos , Colo/cirurgia , Intestinos/fisiopatologia , Óxido Nitroso/efeitos adversos , Complicações Pós-Operatórias/etiologia , Feminino , Gases , Motilidade Gastrointestinal/efeitos dos fármacos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Distribuição AleatóriaRESUMO
Alfentanil 75 micrograms kg-1 or saline (control group) was given 1 min before induction of anaesthesia in 20 healthy patients premedicated with diazepam 0.14 mg kg-1 and pethidine 1 mg kg-1. Anaesthesia was induced with a sleep dose of thiopentone preceded by glycopyrrolate. Suxamethonium 1 mg kg-1 was used to facilitate laryngoscopy (which lasted 10 s) and tracheal intubation. Arterial pressure, heart rate and noradrenaline concentration in mixed venous plasma increased significantly after suxamethonium, and increased further after laryngoscopy and intubation in the control group (n = 10). The QT interval of the ECG was prolonged after the administration of suxamethonium, and was prolonged further after laryngoscopy and intubation. All these changes were attenuated in patients pretreated with alfentanil (n = 10), but four patients had chest wall rigidity. Changes in the QT interval correlated directly with the changes in plasma noradrenaline concentration (r = 0.67). Plasma adrenaline concentrations decreased during induction of anaesthesia in both groups.
Assuntos
Epinefrina/sangue , Fentanila/análogos & derivados , Hemodinâmica/efeitos dos fármacos , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Norepinefrina/sangue , Adulto , Alfentanil , Anestesia , Pressão Sanguínea/efeitos dos fármacos , Feminino , Fentanila/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , SuccinilcolinaRESUMO
The effect of intrapleural bupivacaine in the treatment of post-thoracotomy pain was evaluated. Bupivacaine, 0.5% 20 ml, with adrenaline (5 micrograms/ml) was given through an indwelling intrapleural catheter, at 4-h intervals four times daily for 2 days. No pleural suction was applied during and 10 min after each injection. A control group received intramuscular oxycodone on request. A visual analogue scale (VAS), a pain questionnaire (PQ) and registration of the need for supplementary analgesics were used for the assessment of postoperative analgesia. Blood-gas analyses showed elevated PaCO2 values in both groups on the day of operation and on the first postoperative day, without differences between the groups. Plasma concentrations of bupivacaine did not reach toxic values, and no symptoms of central nervous toxicity or any other untoward reactions were found during the study period. Clinically, there was some pain relief after the intrapleural bupivacaine. The VAS and PQ scores 30 min after bupivacaine instillations diminished to an extent similar to that after oxycodone treatment. The need for analgesics during the day of operation was less in the bupivacaine group than in the control group (P less than 0.001). The number of oxycodone supplementation doses during 48 h postoperatively was, however, not smaller in the bupivacaine group than in the control group.
Assuntos
Bupivacaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Toracotomia/efeitos adversos , Bupivacaína/administração & dosagem , Cateteres de Demora , Ensaios Clínicos como Assunto , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Feminino , Humanos , Injeções Intramusculares , Instilação de Medicamentos , Masculino , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Pleura , Distribuição AleatóriaRESUMO
In liver transplant patients low plasma protein, acid base abnormalities and high citrate concentrations in the blood affects the binding of ionized calcium. In the present study plasma ionized calcium as well as serum total plasma calcium were measured in ten patients undergoing liver transplantation because of end-stage liver failure. During the operation, ionized calcium fell to as low as 0.46 mmol/l although calcium chloride was administered frequently at doses of 10 mg/kg. Serum total calcium concentration values did not fall but rose well above normal at the end of the operation. The measuring of total serum calcium may thus be dangerously misleading in patients undergoing liver transplantation.
Assuntos
Cálcio/sangue , Rejeição de Enxerto , Encefalopatia Hepática/cirurgia , Hepatite Crônica/cirurgia , Complicações Intraoperatórias/sangue , Cirrose Hepática Biliar/cirurgia , Transplante de Fígado , Cloreto de Cálcio/administração & dosagem , Eletrocardiografia , Humanos , Hiperpotassemia/sangue , Hipocalcemia/sangueAssuntos
Analgesia , Bupivacaína/administração & dosagem , Pleura , Toracotomia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
The effect of clonidine (4.5 micrograms kg-1) on haemodynamics and hormonal stress responses was evaluated in 21 female patients undergoing breast surgery. The standardized general anaesthesia included diazepam as premedicant, thiopentone, enflurane, N2O, fentanyl and vecuronium. Venous plasma concentrations of noradrenaline, adrenaline, growth hormone, vasopressin, and cortisol were assayed at various times before, during and after surgery. Clonidine attenuated the sympathoadrenal response; arterial blood pressure and heart rate increases in association with intubation were lower in clonidine-premedicated patients. Noradrenaline levels were lower throughout and 3 h after surgery in the clonidine group (P less than 0.05). Adrenaline levels were lower in this group 2 min after intubation (P less than 0.05). Growth hormone, vasopressin and cortisol plasma levels were increased at the end of and after surgery, with no differences between the groups. In spite of the effect on sympathoadrenal response, clonidine did not have any significant additive anxiolytic effect. Statistically significant differences were not found as to need for postoperative analgesics.
Assuntos
Anestesia Geral , Clonidina/uso terapêutico , Medicação Pré-Anestésica , Estresse Fisiológico/tratamento farmacológico , Administração Oral , Adulto , Idoso , Anestesia Endotraqueal , Ansiedade/sangue , Ansiedade/tratamento farmacológico , Catecolaminas/sangue , Feminino , Hormônio do Crescimento/sangue , Humanos , Hidrocortisona/sangue , Pessoa de Meia-Idade , Dor Pós-Operatória , Distribuição Aleatória , Estresse Fisiológico/sangue , Vasopressinas/sangueRESUMO
Four different pain treatments (single intercostal block with bupivacaine, repeated intercostal block, epidural morphine and epidural bupivacaine infusions) were compared in 39 patients subjected to lung surgery under general anaesthesia. The patients' own estimate of the postoperative pain was not significantly different between the groups, but the epidurally treated patients required fewer doses of supplementary analgesic than those given just a single dose of intercostal bupivacaine. Bupivacaine levels in blood were below the toxic range in all groups. The concentration of antidiuretic hormone in blood was increased early during the operation, and had only partly returned to normal on the first postoperative morning. Growth hormone in plasma was increased only at the end of the operation. Catecholamine levels in blood increased gradually, reaching their peak postoperatively. There were only slight differences between the groups in these posterior and anterior pituitary and sympatho-adrenal responses to surgical stress. Thus, neither repeated intercostal blockade nor epidural administration of morphine or bupivacaine could prevent the endocrine responses to thoracic surgery, in spite of significant, albeit incomplete, pain relief. This was probably caused in part by residual pain, and also by poor access of the extradural medications to the autonomic afferent pathways mediating nociceptive signals from thoracic organs and tissues.
Assuntos
Catecolaminas/sangue , Hormônio do Crescimento/sangue , Neoplasias Pulmonares/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Vasopressinas/sangue , Idoso , Anestesia por Condução , Anestesia Epidural , Bupivacaína/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Medição da Dor , Dor Pós-Operatória/sangue , Fatores de TempoRESUMO
In a controlled study, equipotent doses of atracurium (20 patients) or vecuronium (22 patients) were given randomly to patients with chronic renal failure anaesthetized for renal transplantation. There were no statistically significant differences in the degree of muscle relaxation (electromyographic twitch response) and circulatory parameters. Plasma histamine concentration increased in three patients after the first dose of atracurium, but in none of the patients could any signs of allergic reactions be observed. Tracheal intubation was difficult in six patients of the atracurium group, all of whom had diabetes mellitus and varying degrees of neck stiffness. The neuromuscular block response in diabetic uraemic patients was similar to that in other uraemic patients.
Assuntos
Anestesia Geral , Atracúrio/uso terapêutico , Transplante de Rim , Brometo de Vecurônio/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Histamina/sangue , Humanos , Intubação Intratraqueal , Concentração OsmolarRESUMO
Sixty patients scheduled for colonic surgery were randomly allocated to four groups according to postoperative pain medication: I. Control group, the patients received oxycodone intramuscularly (0.15 mg kg-1) on request. II. Epidural bupivacaine (0.25%) continuously administered by infusion pump, 4-6 ml h-1, for 48 h. III. Epidural morphine, 2-6 mg, at the end of operation and repeated on the first and second postoperative mornings. IV. Epidural morphine, 2-6 mg per die, administered for 48 h continuously by infusion pump. All patients received a balanced anaesthesia with enflurane, fentanyl and vecuronium. Postoperatively, intramuscular oxycodone was given on request. There were no significant differences between the groups in changes in peak flow, spirometry and blood-gas analyses postoperatively. Pain intensity (visual analogue scale) was lower in Groups II and III at 3 h and in Group IV at 24 h compared to the control Group I. All the epidurally treated groups needed less additional analgesics than the control Group I. Postoperatively bowel movements occurred on the second day in Group II (bupivacaine) as compared to the fourth day in all other groups (P less than 0.05).
Assuntos
Bupivacaína/uso terapêutico , Colo/cirurgia , Morfina/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Idoso , Bupivacaína/administração & dosagem , Colo/efeitos dos fármacos , Colo/fisiologia , Feminino , Humanos , Bombas de Infusão , Injeções Epidurais , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagemRESUMO
The purpose of the study was to evaluate the function of mini-tracheostomy as a means of emergency ventilation. Piglets were manually ventilated with a revivator through a mini-tracheostomy tube. In five out of seven experiments good oxygenation was upheld but hypercarbia could not be avoided. If the insertion opening in the trachea was too big, ventilation was not possible. The mini-tracheostomy tube can be used in an emergency situation for oxygenation. However, training is recommended.
Assuntos
Respiração Artificial/métodos , Traqueostomia/métodos , Animais , Cateterismo/instrumentação , Cateterismo/métodos , Serviços Médicos de Emergência , Ratos , Suínos , Traqueostomia/instrumentaçãoRESUMO
Fifty-one patients scheduled for thoracotomy were included in a study involving five different methods of postoperative analgesia. Forty patients were randomly divided into: Group C, receiving intramuscular oxycodone on request following an intraoperative intercostal block; Group IC, intercostal blocks with 0.5% bupivacaine performed prior to surgery, 6 h later and on the first postoperative morning: Group EB, epidural bupivacaine as a continuous infusion of 0.25% bupivacaine (5 ml h-1); Group EM4 epidural morphine 4 mg injected prior to surgery and on the first postoperative morning. In addition, a fifth group (Group EM6) of 11 patients received 6 mg of epidural morphine timed as in Group EM4, but these patients were automatically scheduled to be observed in the ICU. Additional intramuscular oxycodone was given on request to all patients. Group EB, EM4 and EM6 had lower numbers of requests than Group C. Pain intensity score was lowest (2.5 on a scale from 0 to 10, 3 h postoperatively) in Group EM6, and there was a statistically significant difference in pain intensity at 3 h between EM4 and EM6. The evaluation of cooperation and pain by the physical therapist revealed no differences between the groups. Postoperative blood-gas analyses contained slightly elevated PCO2 values (6.0-7.3 kPa) in all groups. Postoperatively, only Group EB was devoid of PCO2 values above 7.3 kPa. Urinary retention was a common complication in the patients receiving epidural analgesia, occurring most frequently in Group EM6; 10 of the 11 patients had to be catheterized.
Assuntos
Analgesia , Cirurgia Torácica , Adulto , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Humanos , Injeções Epidurais , Morfina/administração & dosagem , Morfina/uso terapêutico , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Fatores de TempoAssuntos
Enflurano/metabolismo , Transplante de Fígado , Adulto , Feminino , Fluoretos/metabolismo , Humanos , Fígado/metabolismoRESUMO
Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups according to the postoperative pain treatment. All patients had a standardized balanced anaesthesia and for postoperative analgesia either intramuscular oxycodone and/or metamizol (IM), intercostal block with 0.5% bupivacaine (IC), epidurally 4 mg morphine (EM) or i.v. infusion of fentanyl 0.54-0.99 micrograms min-1 + on-demand boluses of 7.2-13.5 micrograms (ODAC) were given. The pain intensity 2 h postoperatively was similar in all groups, mean score ranging from 3.2-4.3 on a scale from 0-10. At 24 h also, when additional intramuscular analgesics had been administered if needed, the mean pain scores did not vary much; 2.4 in the ODAC group to 3.4 in the IC group. The time until the first request for additional analgesia was longer in the EM group than in the IM group (7.5 h vs. 3.5 h). There were no differences between the groups in chest X-ray, peak expiratory flow or respiratory rate postoperatively, but in the capillary blood-gas analyses there was a greater number of slightly elevated PCO2 values (6.0-7.3 kPa) in the ODAC group than in the others. The amount of fentanyl infused in 24 h to the ODAC patients varied considerably, 814-2233 micrograms, as did the number of on-demand boluses, 3-155. At 24 h, an efficacy rating "good" was distributed as follows: IM 9/20, IC 11/20, EM 11/20 and ODAC 13/20. In the whole patient material 92.5% rated their condition as "good" or "fair".
Assuntos
Analgesia/métodos , Fentanila/administração & dosagem , Morfina/administração & dosagem , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Abdome/cirurgia , Adulto , Benzilatos/administração & dosagem , Benzofenonas/administração & dosagem , Bupivacaína/administração & dosagem , Dipirona/administração & dosagem , Combinação de Medicamentos/administração & dosagem , Espaço Epidural , Feminino , Humanos , Infusões Parenterais , Injeções , Injeções Intramusculares , Músculos Intercostais/inervação , Masculino , Pessoa de Meia-Idade , Oxicodona/administração & dosagem , Respiração/efeitos dos fármacosRESUMO
We have analyzed one human liver transplant by frequent FNABs. We conclude that FNABs of liver transplant recipients is a safe procedure that can be performed repeatedly without danger to the graft or to the graft recipient. The inflammatory episodes of rejection may be recorded and certain changes in the transplant--in particular, cholestasis and deposits of CsA--may be demonstrated in the FNAB as well.