Barbro Scheinin - Academia.edu (original) (raw)
Papers by Barbro Scheinin
Anesthesia and Analgesia, 1964
INCE EARLY in this century,', the in-S sufflation of oxygen and ether by ... *Division o... more INCE EARLY in this century,', the in-S sufflation of oxygen and ether by ... *Division of Anesthesiology, The Johns Hopkins Hospital, Baltimore, Maryland. +Chief, Program Planning, Government of DC, Department of Public Health, Washington, DC This project ...
Acta Anaesthesiologica Scandinavica, 1987
Sixty patients scheduled for colonic surgery were randomly allocated to four groups according to ... more 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 kg1) on request. II. Epidural bupivacaine (0.25%) continuously administered by infusion pump, 66 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 < 0.05).
Survey of Anesthesiology, 1988
Anesthesia and Analgesia, 1984
... INIST Diffusion SA Service Clients / Customer Service 2, allée du parc de Brabois F-54514 Van... more ... INIST Diffusion SA Service Clients / Customer Service 2, allée du parc de Brabois F-54514 Vandoeuvre Cedex France Tél : +33 (0) 3.83.50.46.64 Fax : +33 (0) 3.83.50.46.66 Courriel : infoclient@inist.fr. ... More -&gt; http://international.inist.fr/article39.html. ...
Transplantation, 1984
We have analyzed the inflammatory changes in pig liver allografts and autografts by fine needle a... more We have analyzed the inflammatory changes in pig liver allografts and autografts by fine needle aspiration biopsy (FNAB) and correlated the cytological findings with transplant histology and changes in recipient blood. In nonimmunosuppressed piglets (n = 9) the inflammatory episode of rejection occurred promptly, peaked on days 4-7, and thereafter subsided in cases in which the graft was accepted (n = 6). The early inflammatory infiltrate consisted of all major types of inflammatory leukocytes, including T lymphoblasts, B plasmablasts, and plasma cells, lymphocytes and monocytes; macrophages dominated the late inflammatory lesion of irreversible rejection. In piglets that died of rejection (n = 3), the inflammation peaked earlier and the total amount of inflammation, including the frequency of blast cells and mononuclear phagocytes, was higher. These differences were, however, statistically insignificant and not predictive for irreversible rejection. In sham-operated autograft recipients (n = 5) no inflammation was recorded in the graft. Application of cyclosporine (n = 5), significantly suppressed the total inflammation (P = 0.02 and 0.06 on days 4 and 7, respectively) and delayed the peak; in addition, both the blastogenic component (P = 0.08 on day 4) and the mononuclear phagocyte component (P = 0.03 on day 7) were clearly suppressed. These inflammatory changes, recorded by the FNAB, had a close correlation with biopsy histology. On the other hand, determinations of S-ASAT, S-ALAT, and S-AFOS was not correlated with the episodes of rejection, and no characteristic changes were seen in blood cytology during the rejection episodes either.
Acta Anaesthesiologica Scandinavica, 1982
Morphine 2 mg and 4 mg or bupivacaine 50 mg (another 50 mg 4 h later) was administered into the e... more Morphine 2 mg and 4 mg or bupivacaine 50 mg (another 50 mg 4 h later) was administered into the epidural space prior to general anaesthesia of 40 patients undergoing upper abdominal surgery. During anaesthesia, additional analgesics were not given. In the recovery room (4 h) the pain score (0–10) was lowest in the bupivacaine group (mean 2.4) followed by the 4 mg-morphine group (4.1), 2 mg-morphine group (5.3) and control group (5.7). Half of the patients of the bupivacaine group and those of the 4 mg-morphine group needed no analgesics in the recovery room. Later, in the ward (until next morning 7 am), only morphine patients (5/20) managed without postoperative analgesics. The mean number of requests for analgesics during that time was: 4 mg-morphine 1.3, 2 mg-morphine 1.9, bupivacaine 2.7, and control 2.9. Episodes of hypotension and nausea were most frequent in the bupivacaine group. No serious respiratory complications occurred; 4 h after anaesthesia three patients in the 4 mg-morphine group and two in the bupivacaine group had capillary Pco2 values above 6.65 kPa (50 mmHg), the highest being 7.1 kPa. In two additional patients with choledochal drainage (T-tube), the intracholedochal pressure was shown to rise about 2 kPa (15 mmHg) and 2.7 kPa after epidural injection of 2 mg and 4 mg, respectively. A pressure peak was reached within 10 min and at 75 min the pressure was still 0.7-1.3 kPa above the initial level.
Survey of Anesthesiology, 1990
Survey of Anesthesiology, 1987
... patients reported score 10 at 3 and 24 h postopera-tively despite the fact that the physical ... more ... patients reported score 10 at 3 and 24 h postopera-tively despite the fact that the physical therapist rated his ... The evaluation of pain and cooperation by the physi-cal therapist showed no significant differences between the groups. ... One patient in Group EB with bronchiectasis de ...
British Journal of Anaesthesia, 1991
We have studied the effect of verapamil on the incidence of ECG changes and right ventricular pre... more 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 /?"' (r\ = 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 (F/ Oi 0.60) for 10 min. Atrial tachyarrhythmia (AT) (4/13) and new ischaemic ECG changes (3113) occurred only in the control group (P < 0.05). With an F/ Oj 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 < 0.02). With an Fl 0] of 0.60 for 10 min, systolic RVP decreased more in the control than in the verapamil group (P < 0.01). In the control group, an increase in end-diastolic RVP (P < 0.001) and central venous pressure (P < 0.05) on the first day after operation was predictive of AT occurring on the second day.
Acta Anaesthesiologica Scandinavica, 1987
Four different pain treatments (single intercostal block with bupivacaine, repeated intercostal b... more 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.
Acta Anaesthesiologica Scandinavica, 1995
The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1–2 patient... more 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 ml of either plain 0.15% bupivacaine {150 mg · 100 ml-1) or the same solution with adrenaline (1.5 μg ml-l), 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 μg 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.
Acta Anaesthesiologica Scandinavica, 1984
Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups accordi... more 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 μg min-1 + on-demand boluses of 7.2–13.5 μg (ODAG) 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 μg, 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”.
British Journal of Anaesthesia, 1992
The effects of the new, highly selective alpha 2adrenergic agonist, dexmedetomidine, were studied... more The effects of the new, highly selective alpha 2adrenergic agonist, dexmedetomidine, were studied in a randomized, placebo-controlled, double-blind trial in 24 ASA I patients. Dexmedetomidine 0.6 jug kg'' or saline was given i.v. 10 min before induction of anaesthesia. The required dose of thiopentone was significantly (P < 0.001) smaller in the dexmedetomidine group (mean 4.4 (SD 0.9) mgkg-1 ) than in the control group (6.9 (1.6) mg kg''), and the drug attenuated the cardiovascular responses to laryngoscopy and trachea/ intubation. The concentration of noradrena/ine in mixed venous plasma was smaller in the dexmedetomidine group during all phases of induction (P < 0.01). During surgery, fentanyl was required in a dose of 0.5 (0.6) mg kg-' and2.8 (2.6) mg kg-' in the dexmedetomidine and control groups, respectively (P < 0.001). During 2h postoperative follow-up, oxycodone 0.06 (0.06) mg kg-' and 0.16 (0.1) mg kg~' (P < 0.05) was given to the two groups respectively.
Survey of Anesthesiology, 1990
Forty patients scheduled for elective colonic surgery were allocated at random to receive either ... more 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).
Acta Anaesthesiologica Scandinavica, 1987
The effect of clonidine (4.5 μg kg-1) on haemodynamics and hormonal stress responses was evaluate... more The effect of clonidine (4.5 μg 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<0.05). Adrenaline levels were lower in this group 2 min after intubation (P<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.
Acta Anaesthesiologica Scandinavica, 1989
The effect of intrapleural bupivacaine in the treatment of post–thoracotomy pain was evaluated. B... more The effect of intrapleural bupivacaine in the treatment of post–thoracotomy pain was evaluated. Bupivacaine, 0.5% 20 ml, with adrenaline (5 μg/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 Pacoz 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 < 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.
British Journal of Anaesthesia, 1990
Forty patients scheduled for elective colonic surgery were allocated at random to receive either ... more 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).
Anesthesia and Analgesia, 1964
INCE EARLY in this century,', the in-S sufflation of oxygen and ether by ... *Division o... more INCE EARLY in this century,', the in-S sufflation of oxygen and ether by ... *Division of Anesthesiology, The Johns Hopkins Hospital, Baltimore, Maryland. +Chief, Program Planning, Government of DC, Department of Public Health, Washington, DC This project ...
Acta Anaesthesiologica Scandinavica, 1987
Sixty patients scheduled for colonic surgery were randomly allocated to four groups according to ... more 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 kg1) on request. II. Epidural bupivacaine (0.25%) continuously administered by infusion pump, 66 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 < 0.05).
Survey of Anesthesiology, 1988
Anesthesia and Analgesia, 1984
... INIST Diffusion SA Service Clients / Customer Service 2, allée du parc de Brabois F-54514 Van... more ... INIST Diffusion SA Service Clients / Customer Service 2, allée du parc de Brabois F-54514 Vandoeuvre Cedex France Tél : +33 (0) 3.83.50.46.64 Fax : +33 (0) 3.83.50.46.66 Courriel : infoclient@inist.fr. ... More -&gt; http://international.inist.fr/article39.html. ...
Transplantation, 1984
We have analyzed the inflammatory changes in pig liver allografts and autografts by fine needle a... more We have analyzed the inflammatory changes in pig liver allografts and autografts by fine needle aspiration biopsy (FNAB) and correlated the cytological findings with transplant histology and changes in recipient blood. In nonimmunosuppressed piglets (n = 9) the inflammatory episode of rejection occurred promptly, peaked on days 4-7, and thereafter subsided in cases in which the graft was accepted (n = 6). The early inflammatory infiltrate consisted of all major types of inflammatory leukocytes, including T lymphoblasts, B plasmablasts, and plasma cells, lymphocytes and monocytes; macrophages dominated the late inflammatory lesion of irreversible rejection. In piglets that died of rejection (n = 3), the inflammation peaked earlier and the total amount of inflammation, including the frequency of blast cells and mononuclear phagocytes, was higher. These differences were, however, statistically insignificant and not predictive for irreversible rejection. In sham-operated autograft recipients (n = 5) no inflammation was recorded in the graft. Application of cyclosporine (n = 5), significantly suppressed the total inflammation (P = 0.02 and 0.06 on days 4 and 7, respectively) and delayed the peak; in addition, both the blastogenic component (P = 0.08 on day 4) and the mononuclear phagocyte component (P = 0.03 on day 7) were clearly suppressed. These inflammatory changes, recorded by the FNAB, had a close correlation with biopsy histology. On the other hand, determinations of S-ASAT, S-ALAT, and S-AFOS was not correlated with the episodes of rejection, and no characteristic changes were seen in blood cytology during the rejection episodes either.
Acta Anaesthesiologica Scandinavica, 1982
Morphine 2 mg and 4 mg or bupivacaine 50 mg (another 50 mg 4 h later) was administered into the e... more Morphine 2 mg and 4 mg or bupivacaine 50 mg (another 50 mg 4 h later) was administered into the epidural space prior to general anaesthesia of 40 patients undergoing upper abdominal surgery. During anaesthesia, additional analgesics were not given. In the recovery room (4 h) the pain score (0–10) was lowest in the bupivacaine group (mean 2.4) followed by the 4 mg-morphine group (4.1), 2 mg-morphine group (5.3) and control group (5.7). Half of the patients of the bupivacaine group and those of the 4 mg-morphine group needed no analgesics in the recovery room. Later, in the ward (until next morning 7 am), only morphine patients (5/20) managed without postoperative analgesics. The mean number of requests for analgesics during that time was: 4 mg-morphine 1.3, 2 mg-morphine 1.9, bupivacaine 2.7, and control 2.9. Episodes of hypotension and nausea were most frequent in the bupivacaine group. No serious respiratory complications occurred; 4 h after anaesthesia three patients in the 4 mg-morphine group and two in the bupivacaine group had capillary Pco2 values above 6.65 kPa (50 mmHg), the highest being 7.1 kPa. In two additional patients with choledochal drainage (T-tube), the intracholedochal pressure was shown to rise about 2 kPa (15 mmHg) and 2.7 kPa after epidural injection of 2 mg and 4 mg, respectively. A pressure peak was reached within 10 min and at 75 min the pressure was still 0.7-1.3 kPa above the initial level.
Survey of Anesthesiology, 1990
Survey of Anesthesiology, 1987
... patients reported score 10 at 3 and 24 h postopera-tively despite the fact that the physical ... more ... patients reported score 10 at 3 and 24 h postopera-tively despite the fact that the physical therapist rated his ... The evaluation of pain and cooperation by the physi-cal therapist showed no significant differences between the groups. ... One patient in Group EB with bronchiectasis de ...
British Journal of Anaesthesia, 1991
We have studied the effect of verapamil on the incidence of ECG changes and right ventricular pre... more 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 /?"' (r\ = 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 (F/ Oi 0.60) for 10 min. Atrial tachyarrhythmia (AT) (4/13) and new ischaemic ECG changes (3113) occurred only in the control group (P < 0.05). With an F/ Oj 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 < 0.02). With an Fl 0] of 0.60 for 10 min, systolic RVP decreased more in the control than in the verapamil group (P < 0.01). In the control group, an increase in end-diastolic RVP (P < 0.001) and central venous pressure (P < 0.05) on the first day after operation was predictive of AT occurring on the second day.
Acta Anaesthesiologica Scandinavica, 1987
Four different pain treatments (single intercostal block with bupivacaine, repeated intercostal b... more 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.
Acta Anaesthesiologica Scandinavica, 1995
The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1–2 patient... more 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 ml of either plain 0.15% bupivacaine {150 mg · 100 ml-1) or the same solution with adrenaline (1.5 μg ml-l), 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 μg 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.
Acta Anaesthesiologica Scandinavica, 1984
Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups accordi... more 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 μg min-1 + on-demand boluses of 7.2–13.5 μg (ODAG) 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 μg, 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”.
British Journal of Anaesthesia, 1992
The effects of the new, highly selective alpha 2adrenergic agonist, dexmedetomidine, were studied... more The effects of the new, highly selective alpha 2adrenergic agonist, dexmedetomidine, were studied in a randomized, placebo-controlled, double-blind trial in 24 ASA I patients. Dexmedetomidine 0.6 jug kg'' or saline was given i.v. 10 min before induction of anaesthesia. The required dose of thiopentone was significantly (P < 0.001) smaller in the dexmedetomidine group (mean 4.4 (SD 0.9) mgkg-1 ) than in the control group (6.9 (1.6) mg kg''), and the drug attenuated the cardiovascular responses to laryngoscopy and trachea/ intubation. The concentration of noradrena/ine in mixed venous plasma was smaller in the dexmedetomidine group during all phases of induction (P < 0.01). During surgery, fentanyl was required in a dose of 0.5 (0.6) mg kg-' and2.8 (2.6) mg kg-' in the dexmedetomidine and control groups, respectively (P < 0.001). During 2h postoperative follow-up, oxycodone 0.06 (0.06) mg kg-' and 0.16 (0.1) mg kg~' (P < 0.05) was given to the two groups respectively.
Survey of Anesthesiology, 1990
Forty patients scheduled for elective colonic surgery were allocated at random to receive either ... more 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).
Acta Anaesthesiologica Scandinavica, 1987
The effect of clonidine (4.5 μg kg-1) on haemodynamics and hormonal stress responses was evaluate... more The effect of clonidine (4.5 μg 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<0.05). Adrenaline levels were lower in this group 2 min after intubation (P<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.
Acta Anaesthesiologica Scandinavica, 1989
The effect of intrapleural bupivacaine in the treatment of post–thoracotomy pain was evaluated. B... more The effect of intrapleural bupivacaine in the treatment of post–thoracotomy pain was evaluated. Bupivacaine, 0.5% 20 ml, with adrenaline (5 μg/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 Pacoz 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 < 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.
British Journal of Anaesthesia, 1990
Forty patients scheduled for elective colonic surgery were allocated at random to receive either ... more 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).