Biomedical subjects
Publications and source records attributed to A S Olesen.
A case of phantom limb pain, which had not successfully responded to a long list of medical therapy or neurosurgery, is presented. After oral ketamine treatment was instituted the patient became free of pain. A possible mode of action is described.
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In a randomized, double-blind study of 40 patients undergoing total abdominal hysterectomy, we have compared continuous subcutaneous infusion (CSCI) of morphine with discontinuous extradural injection of morphine for postoperative analgesia at rest and during cough. The CSCI group received a bolus of morphine 0.1 mg kg-1 i.v. at the end of the operation and continued with s.c. infusion of morphine 30 micrograms kg-1 h-1. The extradural group received morphine 4 mg extradurally at 0, 2, 10 and 18 h after operation. Pain and side effects were evaluated at 2, 4, 8, 12 and 24 h after operation. In the extradural group, significantly smaller pain-scores were observed both at rest and during cough compared with the CSCI group. No significant difference was observed between the groups regarding supplementary doses of morphine, peak expiratory flow values or side effects. We conclude that morphine by CSCI is not as effective as morphine injected extradurally. However, CSCI seems to provide simple and relatively effective analgesia with a low rate of side effects.
The larynx mask (LM) is an alternative to a mask and endotracheal tube. LM ensures free airway for the patient under anaesthesia while the anaesthetist has his hands free. The mask is introduced into the pharynx in the anaesthetized patient without use of muscle relaxants or laryngoscope. The literature is reviewed. The possibilities for employment are discussed and the authors' personal experience is presented.
Guanethidine blockade was employed in 22 patients with causalgia, hyperpathia and reflex dystrophy in an upper limb. Guanethidine was administered by means of regional intravenous technique in which 20 mg guanethidine was mixed with 400 IU of heparin and 70 mg lignocaine. Avascularity was present for 20 minutes. The number of blockades was determined in advance. In 68% of the patients, beneficial results occurred as they were relieved of pain or improved considerably. Employment of lignocaine in the injection solution made the blockade less painful.
This retrospective study was undertaken to evaluate the mortality and morbidity of patients undergoing hip fracture surgery within 12 h of admission, compared with surgery more than 12 h after admission, the patients had no acute medical conditions that required preoperative treatment. Mortality rates were based on survival of the patients up to 1 year after surgery. For patients with fractures of the femoral neck, and in whom surgery was performed within 12 hours of admission, the mortality rate was significantly lower from 5 months after the operation. Time of surgery did not influence the mortality of patients with trochanteric fractures. It is suggested that a fractured neck of the femur in an otherwise fit elderly patient should be regarded as a surgical emergency.
A material of 100 patients aged 18-70 years, ASA groups 1-2, who were otherwise healthy with slight generalized sequelae of their illness but without limitations in their usual habits, who were admitted for gastroscopy were randomized to sedation with either diazepam or propofol. Prior to the examination, 0.2 mg/kg diazepam or 1 mg/kg propofol was administered. If necessary, this was supplemented with half of the initial dosage. No difference were found in the sedation. Patients in the propofol group remembered the surgeon's information significantly better and woke significantly more rapidly. Propofol caused significantly more pain on injection. We consider that propofol can be employed for outpatient gastroscopy.
During the period 1 January 1989 to 31 December 1989, a total of 1,004 patients were submitted to outpatient single-day surgery in Aalborg Hospital. As fas as possible, the patients were anaesthetized with propofol (Diprivan)/alfentanil (Rapifen) and oxygen and atmospheric air. This form of anaesthesia was found to be rapid and suitable for single-day surgery. 8.1% of the patients required admission for further observation, 2.3% of these on account of anaesthesiological complications. It is concluded that, by means of meticulous planning, it is possible to carry out ambulant anaesthesia and surgery and, employing limited staff resources, it has proved possible to reduce the waiting time for outpatient intervention to 10-12 weeks.
Nine patients with terminal cancer were treated for pain with continuous subcutaneous injection of morphine via a portable battery-driven injection pump. Treatment was instituted on account of failure of other forms of treatment with oral or epidural morphine derivatives or on account of severe nausea and vomiting which necessitated parenteral administration. Treatment proved reasonably effective and no side effects of significance occurred. Two of the patients could be treated in their homes. The method is thus considered as suitable for treatment of pain in patients with terminal cancer.
Serotonin is a vasoactive amine. It is formed in the chromaffin cells in the small intestine and is inactivated in the liver and lungs. The remainder is taken up in the thrombocytes so that only minimal quantities are found free in the plasma. The peripheral effect of serotonin occurs probably exclusively by means of a release of amine from the thrombocytes following local aggregation of these. Serotonin is thought to play a pathogenetic role in both systemic and pulmonary hypertension. Ketanserin is a serotonin antagonist with alpha-blocking effect. It reduces the blood pressure by reducing the peripheral vascular resistance without causing reflex tachycardia or fall in the minute volume of the heart. In the field of anaesthesiology, it may be employed in per- and postoperative hypertension but on account of the peripheral vasodilating effect it may also be employed in other conditions with peripheral vasoconstriction. Ketanserin has a moderate effect in cases of acutely developed pulmonary hypertension.
Serotonin is a vasoactive amine which is considered to play a pathogenetic role in systemic hypertension on account of the peripharal vasotonic effect of serotonin. The central serotoninergic neurones excitatory influence of the sympathetic tone may, however, be a contributory cause. Urapidil is a selective S1-serotonic receptor-agonist with alpha-blocking effect. This is considered to influence the presynaptic receptors of the serotoninergic neurones and thus to inhibit the excitatory influence on the sympathetic system. It reduces the blood pressure by reducing the peripheral vascular resistance without simultaneous provocation of reflex tachycardia or reduction in the minute volume of the heart. In anaesthesiology, this may be employed for perioperative hypertension. The preparation appears to be particularly useful in neuroanaesthesia as in contrast to other antihypertensive agents, it does not appear to alter the intracranial pressure.
The frequency of local venous reactions after intravenous injection of Diazemuls and Valium Mixed Micelles was studied. A material of 224 patients undergoing surgery for prolapsed lumbar disc was allocated into two groups, receiving either 10 mg of Diazemuls or Valium Mixed Micelles. The incidences of thrombophlebitis in the two groups were 1 and 2%, respectively.
The effects of acute respiratory acid base changes on the ionized calcium concentration were studied in mechanically ventilated patients and compared to the results which were found using an in vitro model. In both in vivo and in vitro studies, the ionized calcium changes correlated negatively with the pH variations. The good agreement between the in vivo and in vitro investigations showed a mean ionized calcium change of 0.40 mmol/l per pH unit. At the same time, the ionized calcium changes correlated positively with the changes of plasma bicarbonate. The mean ionized calcium change was 0.01 mmol/l per mmol/l bicarbonate variation. During respiratory acid base disturbances, the ionized calcium variations due to the competitive albumin binding between hydrogen and calcium ions are buffered and blunted by the bicarbonate ions.
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In order to compare subarachnoid (spinal) and epidural block for caesarean section, 40 women were randomly allocated to spinal or epidural analgesia with bupivacaine. The median dose of bupivacaine was 13 mg in the spinal group versus 155 mg in the epidural group. The mean time from induction to delivery was 32 min shorter in the spinal group (P less than 0.001). In the spinal group one woman was excluded because of spontaneous labour. Three patients in the spinal and one in the epidural group failed to develop adequate analgesia to initiate surgery. For the remaining patients both techniques provided good analgesia during operation. Postoperatively, epidural block provided better pain relief. The patients in the epidural group had a lower pain score during the first 4 h after the operation (P less than 0.01). In spite of similar haemodynamic changes in the two groups, the mean base deficit in umbilical cord blood at delivery was higher in the spinal group (P less than 0.05).
A fatal poisoning with a herbicide which contains chlorinated phenoxy acid derivatives is reported with a special attention to the profound disturbances in calcium homeostasis related to an acute renal failure with hyperphosphatemia.
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