Pub Date : 1998-01-01DOI: 10.1111/j.1399-6576.1998.tb04980.x
K Rehder
Changes in body position alters the functional residual capacity (FRC). Most anesthetics reduce FRC in the recumbent but not sitting position. Inspired gas distribution in anesthesia‐paralyzed subjects whose lungs are mechanically ventilated, is different from that in the awake state in all but the prone position. The function of the diaphragm is altered by postural changes. The pattern of motion of the diaphragm is different during mechanical ventilation than during spontaneous breathing. Also the end‐expiratory shape is affected by induction of anesthesia, but this shape change contributes little to the reduction of FRC. The distribution of pulmonary blood flow is determined not only by gravity, but also by an intrinsic non‐gravity dependent factor. These two factors can be additive in some positions but opposing in others.
{"title":"Postural changes in respiratory function.","authors":"K Rehder","doi":"10.1111/j.1399-6576.1998.tb04980.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1998.tb04980.x","url":null,"abstract":"Changes in body position alters the functional residual capacity (FRC). Most anesthetics reduce FRC in the recumbent but not sitting position. Inspired gas distribution in anesthesia‐paralyzed subjects whose lungs are mechanically ventilated, is different from that in the awake state in all but the prone position. The function of the diaphragm is altered by postural changes. The pattern of motion of the diaphragm is different during mechanical ventilation than during spontaneous breathing. Also the end‐expiratory shape is affected by induction of anesthesia, but this shape change contributes little to the reduction of FRC. The distribution of pulmonary blood flow is determined not only by gravity, but also by an intrinsic non‐gravity dependent factor. These two factors can be additive in some positions but opposing in others.","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"113 ","pages":"13-6"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1998.tb04980.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20838262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1998-01-01DOI: 10.1111/j.1399-6576.1998.tb04985.x
A Haegerstrand
My task is to present where the pharmaceutical industry is today with regards to developing new therapies for the treatment of pain. Having been given this opportunity on a the day when Torsten Gordh Senior celebrates his 90th birthday is a great honor. Since his pioneering work in the area of anesthesia several steps forward have been taken for the patients in finding different and improved opportunities to treat their pain. It is also fair to say that in comparison to other therapeutic areas, not many principally new pharmaceuticals have been established in several years. Still, morphine and variants of opioids with novel delivery systems and modified NSAIDs, all with moderately improved side effect profiles, are still dominating for moderate to severe pain. For the patients responding poorly to morphine and NSAIDs, drugs developed for other indications, e.g. epilepsy and depression, are continuously tried with incomplete success and problems with unwanted side-effects remain. This means that there is still a huge medical need to be met and that the pharmaceutical industry must meet that challenge together with academic groups. Fortunately, it is true that pain is becoming more recognized as an area with a great medical need and that the pharmaceutical industry is increasing its efforts in this area.
{"title":"Trends and targets for treatment of pain, a pharmaceutical industry perspective.","authors":"A Haegerstrand","doi":"10.1111/j.1399-6576.1998.tb04985.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1998.tb04985.x","url":null,"abstract":"My task is to present where the pharmaceutical industry is today with regards to developing new therapies for the treatment of pain. Having been given this opportunity on a the day when Torsten Gordh Senior celebrates his 90th birthday is a great honor. Since his pioneering work in the area of anesthesia several steps forward have been taken for the patients in finding different and improved opportunities to treat their pain. It is also fair to say that in comparison to other therapeutic areas, not many principally new pharmaceuticals have been established in several years. Still, morphine and variants of opioids with novel delivery systems and modified NSAIDs, all with moderately improved side effect profiles, are still dominating for moderate to severe pain. For the patients responding poorly to morphine and NSAIDs, drugs developed for other indications, e.g. epilepsy and depression, are continuously tried with incomplete success and problems with unwanted side-effects remain. This means that there is still a huge medical need to be met and that the pharmaceutical industry must meet that challenge together with academic groups. Fortunately, it is true that pain is becoming more recognized as an area with a great medical need and that the pharmaceutical industry is increasing its efforts in this area.","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"113 ","pages":"31-3"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1998.tb04985.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20838267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Proceedings of the 3rd Vienna International Anesthesiology and Intensive Care Congress. Vienna, Austria, September 29-October 2, 1998.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"112 ","pages":"7-273"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20754837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1998-01-01DOI: 10.1111/j.1399-6576.1998.tb04981.x
A L Eriksson, B Hallén, M Lagerkranser, E Persson, E Sköldefors
Background: Postdural puncture headache (PDPH) and backache are well known complications of spinal anaesthesia. The incidence of PDPH may be significant in young people (< 50 years). The present study was undertaken in order to compare the utility and complication rate of the Whitacre and Ouincke spinal needles.
Methods: During three years all patients who could comply, and who were to undergo spinal anaesthesia at the Department were asked to join this quality control study. Each one received a questionnaire including questions about discomfort and other possible side effects attributed to spinal anaesthesia. In each case, an extended anaesthetic record was filled out by the anaesthesiologist. About 50 anaesthesiologists at different educational levels were involved.
Results: The study includes 2598 cases, of which questionnaires were returned by 66%. Needles of the 25 G gauge size were used in over 90% of the cases. Multiple skin punctures were required more frequently in the Quincke than in the Whitacre group (P < 0.01). The number of insufficient blocks was also higher in the Quincke group (P < 0.01). There was a higher incidence of backache in the Quincke group (P < 0.05). In patients under 50 years, PDPH was more frequent following use of the Quincke needle (P < 0.05), whereas no difference between the needles in this regard was found among those over 50 years (P > 0.05).
Conclusions: For routine clinical use the Whitacre needle appears to be associated with better performance and increased reliability. In younger patients the Whitacre needle have the additional advantage of decreasing the risk of postdural puncture headache.
{"title":"Whitacre or Quincke needles--does it really matter.","authors":"A L Eriksson, B Hallén, M Lagerkranser, E Persson, E Sköldefors","doi":"10.1111/j.1399-6576.1998.tb04981.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1998.tb04981.x","url":null,"abstract":"<p><strong>Background: </strong>Postdural puncture headache (PDPH) and backache are well known complications of spinal anaesthesia. The incidence of PDPH may be significant in young people (< 50 years). The present study was undertaken in order to compare the utility and complication rate of the Whitacre and Ouincke spinal needles.</p><p><strong>Methods: </strong>During three years all patients who could comply, and who were to undergo spinal anaesthesia at the Department were asked to join this quality control study. Each one received a questionnaire including questions about discomfort and other possible side effects attributed to spinal anaesthesia. In each case, an extended anaesthetic record was filled out by the anaesthesiologist. About 50 anaesthesiologists at different educational levels were involved.</p><p><strong>Results: </strong>The study includes 2598 cases, of which questionnaires were returned by 66%. Needles of the 25 G gauge size were used in over 90% of the cases. Multiple skin punctures were required more frequently in the Quincke than in the Whitacre group (P < 0.01). The number of insufficient blocks was also higher in the Quincke group (P < 0.01). There was a higher incidence of backache in the Quincke group (P < 0.05). In patients under 50 years, PDPH was more frequent following use of the Quincke needle (P < 0.05), whereas no difference between the needles in this regard was found among those over 50 years (P > 0.05).</p><p><strong>Conclusions: </strong>For routine clinical use the Whitacre needle appears to be associated with better performance and increased reliability. In younger patients the Whitacre needle have the additional advantage of decreasing the risk of postdural puncture headache.</p>","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"113 ","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1998.tb04981.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20838263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To Torsten Gordh senior: I was asked to participate in this celebration day arranged because of your 90 years birthday, and I am really glad to do so, in order to honor my father. In my lecture I will connect to Torsten Gordh senior's deep and well known interest for the spinal cord and anaesthesia/analgesia, and today discuss the role of nitric oxide (NO) in the spinal cord, and its importance for neuropathic pain and neurodegeneration.
{"title":"The role of nitric oxide in neuropathic pain and neurodegeneration.","authors":"T Gordh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To Torsten Gordh senior: I was asked to participate in this celebration day arranged because of your 90 years birthday, and I am really glad to do so, in order to honor my father. In my lecture I will connect to Torsten Gordh senior's deep and well known interest for the spinal cord and anaesthesia/analgesia, and today discuss the role of nitric oxide (NO) in the spinal cord, and its importance for neuropathic pain and neurodegeneration.</p>","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"113 ","pages":"29-30"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20838266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1998-01-01DOI: 10.1111/j.1399-6576.1998.tb04982.x
L Irestedt
LTHOUGH the use of subarachnoid blockade in obA stetrics was described only few years after the first report of spinal anaesthesia by Bier 1899 (1) it is not until the last 5-10 years that spinal anaesthesia has become the most frequently used anaesthetic method for caesarean section at our hospital. Currently around 750 caesarean sections are performed annually at the Department of Obstetrics and Gynaecology, Karolinska Hospital. Around 40% of them are being performed electively and in more than 90% of these cases spinal anaesthesia is employed as the sole anaesthetic method. In the remaining non-scheduled caesarean deliveries, spinal anaesthesia is currently used in at least 60-70 YO of all cases. The reasons for the rapid increase in the use of spinal anaesthesia for caesarean section are manifold and will be discussed below.
{"title":"Spinal anaesthesia for caesarean delivery.","authors":"L Irestedt","doi":"10.1111/j.1399-6576.1998.tb04982.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1998.tb04982.x","url":null,"abstract":"LTHOUGH the use of subarachnoid blockade in obA stetrics was described only few years after the first report of spinal anaesthesia by Bier 1899 (1) it is not until the last 5-10 years that spinal anaesthesia has become the most frequently used anaesthetic method for caesarean section at our hospital. Currently around 750 caesarean sections are performed annually at the Department of Obstetrics and Gynaecology, Karolinska Hospital. Around 40% of them are being performed electively and in more than 90% of these cases spinal anaesthesia is employed as the sole anaesthetic method. In the remaining non-scheduled caesarean deliveries, spinal anaesthesia is currently used in at least 60-70 YO of all cases. The reasons for the rapid increase in the use of spinal anaesthesia for caesarean section are manifold and will be discussed below.","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"113 ","pages":"21-3"},"PeriodicalIF":0.0,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1998.tb04982.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20838264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1997-01-01DOI: 10.1111/j.1399-6576.1997.tb05523.x
K Ugurbil
Historically, the most compelling argument for the existence of regional specialization of human brain function was presented by Pierre Paul Broca in the middle 19th century. Broca examined a patient who, as a result of a stroke, presented with the problem of inability to speak or aphasia but was otherwise normal. Based on an autopsy performed subsequent to the patient's death, Broca concluded that the seat of the damage was an egg size lesion located in the inferior frontal gyrus of the frontal lobe in the left hemisphere; this general area is now commonly referred to as Broca's area although its precise topographical extent remains somewhat ambiguous. Such lesion studies and, later intraoperative mapping efforts with electrodes have been until now the primary source of our current understanding of functional compartmentation in the human brain. Recent techniques permit the acquisition of such information much more rapidly and with greater spatial accuracy, fueling explosive developments in our investigation of human brain function. For example, the language area first identified by Broca can now be visualized with unprecedented spatial resolution using functional magnetic resonance imaging (NRI) , in data collection times that last only a few minutes. The most significant and revolutionary advance in magnetic resonance imaging in the last several years has been the use of this methodology to non-invasively map areas of increased neuronal activity in the human brain without the use of exogenous contrast agents. Since its initial demonstration (e.g. [1-31), functional magnetic resonance imaging (NRI) has been applied to study a variety of neuronal processes, ranging from activities in the primary sensory and motor cortices to cognitive functions including attention, language, learning, and memory. The majority of NRI experiments are based on the blood oxygenation level dependent (BOLD) contrast [4] which is derived from the fact that deoxyhemoglobin is paramagnetic, and changes in the local concentration of deoxyhemoglobin within the brain lead to alterations in the magnetic resonance signal. In BOLD based NRI, there exists two related but different mechanism underlying the origin of the MRI signal changes coupled to the presence of deoxyhemoglobin; both of these arise because deoxyhemoglobin is compartmentalized within red blood cells in the blood and within blood vessels in the tissue. In the presence of the paramagnetic deoxyhemoglobin, the bulk susceptibility and consequently the magnetic field, of the compartment containing deoxyhemoglobin is different compared to the surrounding environment. Outside the boundaries of this compartment, the magnetic field gradually changes over distances comparable to dimensions of the compartment itself to assume the characteristic value associated with the surrounding environment. This leads to magnetic field gradients immediately outside the deoxyhemoglobin compartment. When these distances are small compa
{"title":"Mapping brain function with magnetic resonance imaging.","authors":"K Ugurbil","doi":"10.1111/j.1399-6576.1997.tb05523.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05523.x","url":null,"abstract":"Historically, the most compelling argument for the existence of regional specialization of human brain function was presented by Pierre Paul Broca in the middle 19th century. Broca examined a patient who, as a result of a stroke, presented with the problem of inability to speak or aphasia but was otherwise normal. Based on an autopsy performed subsequent to the patient's death, Broca concluded that the seat of the damage was an egg size lesion located in the inferior frontal gyrus of the frontal lobe in the left hemisphere; this general area is now commonly referred to as Broca's area although its precise topographical extent remains somewhat ambiguous. Such lesion studies and, later intraoperative mapping efforts with electrodes have been until now the primary source of our current understanding of functional compartmentation in the human brain. Recent techniques permit the acquisition of such information much more rapidly and with greater spatial accuracy, fueling explosive developments in our investigation of human brain function. For example, the language area first identified by Broca can now be visualized with unprecedented spatial resolution using functional magnetic resonance imaging (NRI) , in data collection times that last only a few minutes. The most significant and revolutionary advance in magnetic resonance imaging in the last several years has been the use of this methodology to non-invasively map areas of increased neuronal activity in the human brain without the use of exogenous contrast agents. Since its initial demonstration (e.g. [1-31), functional magnetic resonance imaging (NRI) has been applied to study a variety of neuronal processes, ranging from activities in the primary sensory and motor cortices to cognitive functions including attention, language, learning, and memory. The majority of NRI experiments are based on the blood oxygenation level dependent (BOLD) contrast [4] which is derived from the fact that deoxyhemoglobin is paramagnetic, and changes in the local concentration of deoxyhemoglobin within the brain lead to alterations in the magnetic resonance signal. In BOLD based NRI, there exists two related but different mechanism underlying the origin of the MRI signal changes coupled to the presence of deoxyhemoglobin; both of these arise because deoxyhemoglobin is compartmentalized within red blood cells in the blood and within blood vessels in the tissue. In the presence of the paramagnetic deoxyhemoglobin, the bulk susceptibility and consequently the magnetic field, of the compartment containing deoxyhemoglobin is different compared to the surrounding environment. Outside the boundaries of this compartment, the magnetic field gradually changes over distances comparable to dimensions of the compartment itself to assume the characteristic value associated with the surrounding environment. This leads to magnetic field gradients immediately outside the deoxyhemoglobin compartment. When these distances are small compa","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"113-5"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05523.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20192821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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