Ma zui xue za zhi = Anaesthesiologica Sinica最新文献

The analgesic efficacy, side effects, and satisfaction of patient-controlled analgesia (PCA) with intravenous and epidural morphine for postoperative pain were evaluated in this study. Twenty patients undergoing major joint replacement surgery were randomly allocated to intravenous PCA (IPCA) group or epidural PCA (EPCA) group. All patients had a standardized balanced anesthesia, and an epidural catheter was introduced after the operation in EPCA group. Postoperative pain relief was evaluated with verbal pain scale. The result showed that pain intensity and pain relief were similar in either group without significant difference (p greater than 0.05). Morphine consumption in IPCA group was 1.72 +/- 0.30 mg/h in the postoperative 0 - 12 h and 1.14 +/- 0.44 mg/h in 12 - 24 h. In EPCA group, relatively low doses of morphine were used, i.e., 0.20 +/- 0.07 mg/h in the postoperative 0 - 12 h and 0.17 +/- 0.07 mg/h in 12 - 24 h. Both groups showed an "incomplete" but satisfactory analgesia with relatively low doses of morphine. The "equianalgesic dose ratio" of IPCA to EPCA with morphine was approximately 8.5:1. Sedation was minimal in both groups. No respiratory depression developed in all patients. Nausea and vomiting were the most prominent side effects which might limit the usefulness of PCA. The incidence was 5 out of 10 patients in IPCA group and 4 out of 10 patients in EPCA group, despite under the treatment of droperidol (15 micrograms/kg, iv, prn) for most of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

We examined results of brachial plexus block in 31 young male patients who underwent upper extremity surgical procedures. Interscalene block was performed using a paresthesia technique in 13 patients and axillary block, using the perivascular technique, in 18 patients. In both groups, 30 ml 1.5% lidocaine with 1:200,000 epinephrine was injected. Sensory blockade was evaluated at 5 min and 15 min after injection, determined by pinprick. Results showed that the interscalene technique preferentially blocked the cephalad nerves while the axillary technique produced similar block of both cephalad and caudal nerves of the brachial plexus. Difference between groups was statistically significant, suggesting that the extent of nerve block depends on the technique of approach per se. The difference in patterns of nerve blocked by either technique could be due to the access of local anesthetic to the different components of plexus in the sheath.

For hospital personnel, transmission of virus is a common and serious occupational hazard. Other than suffering from physical discomfort, these infected hospital staffs may also transmit the disease to patients through their blood, mucous or secretion contamination. The purpose of this study is intended to understand the condition of hepatitis B virus infection between anesthetists and hospital administration staffs. Forty-six anesthetists (study group) and 90 hospital administration staffs (control group) were volunteers of the study. Blood samples for serologic and biochemical test of hepatitis B virus infection in each participant were proceeded from October to December 1990. To investigate personal recognition about hepatitis B infection, each was requested to fill up a questionnaire after blood sampling. We also retrieved the chart of all participators for their annual hepatitis B serologic result in order to find out the incidence of seroconversion. Among the 136 participators, 20 (14.7%) were HbsAg carriers. Only 28 (20.6%) of all the participators were free from infection and seronegative. However, it was found that there was no significant difference (P greater than 0.05) between the two groups, no matter in HbsAg positive or seronegative incidence. There was 10 (1.27%) incidence of seroconversion during 790 times of person-year observation. Though not significant (P less than 0.05), there was a double fold (2.2 times) seroconversion rate in the study group than that of the control group. Twenty (19.9%) seropositive participators knew that they are hepatitis B carrier or had been infected. Generally, anesthetists seemed better than hospital administration staffs in realizing that they were infected or carrier from the data of serological test.(ABSTRACT TRUNCATED AT 250 WORDS)

Circumcision often followed by severe pain during the postoperative period. Forty boys, ASA class I, presenting for day case circumcision were allocated randomly to receive either 4% prilocaine hydrochloride spray or 1.1% dipucaine ointment at the end of the operation. Analgesia was assessed by a single observer utilizing a three-point scale in recovery room. The parents were asked to complete the questionnaire 8h following operation and on the morning of the first postoperative day. At approximately 24h following operation an assessment of the child's activity level was made by the parents. The frequency of taking the oral analgesia was also recorded. Both topical analgesics provided satisfied analgesia during the postoperative period and no complication was noted. Only one patient in dipucaine group vomited in the recovery room. We conclude that topical use of prilocaine hydrochloride and dipucaine can provide a simple, safe and adequate analgesia for post-circumcision pain relief.

The incidence of hypotension induced by spinal anesthesia in 154 ASA class I or II patients having Cesarean section and postpartum bilateral tubal ligation was studied. Xylocaine (2%) 60-65 mg was used for spinal anesthesia. There was 41.0% of patients in Cesarean section group developed hypotension induced by spinal anesthesia, and 13.5% in tubal ligation group. We found no correlation between the time after delivery and the occurrence of hypotension induced by spinal anesthesia. In addition, 20.3% of the patients in tubal ligation group required intravenous narcotics because of inadequate sensory blockade during skin incision, but only 9.0% in Cesarean section needed the same supplement which was due to visceral pain during intra-abdominal manipulation. We conclude that spinal anesthesia with 2% xylocaine is safe and effective in both Cesarean section and postpartum tubal ligation although a significant difference of spinal hypotension existed.

During the procedure of coronary artery bypass graft surgery (CABG), the release of free oxygen radicals as a result of ischemia and reperfusion which plants the seeds of post-operative low cardiac output and arrhythmias has grave consequence on the reestablishment of cardiac function. A variety of chemical agents such as mannitol, allopurinol, catalase (Q-10) and superoxide dismutase (SOD) has proved to be considerably effective to improve the myocardial necrosis following ischemia and reperfusion. In this study we chose mannitol (0.2 gm/kg) as the free oxygen radicals scavenger and utilized mass spectrophotometric method to detect the variation of concentration of [H2O2], a by-product of free oxygen radical, in an attempt to evaluate the efficacy of mannitol in this regard in patients undergoing CABG. Patients were divided into experimental group (n = 19) and control group (n = 20). In the experimental group the concentration of [H2O2] changed from 61 +/- 24 microM/L pre-operatively to 77 +/- 18 microM/L post-operatively as against 75 +/- 31 microM/L and 99 +/- 31 microM/L respectively in the control group. In comparison, only the change in experimental group was statistically significant (p less than 0.05). We confirmed that mannitol functions considerably as a free oxygen radical scavenger since it reduces the production of [H2O2] in patients undergoing CABG.