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D N Mihic

Publications and source records attributed to D N Mihic.

10 recordsLinked to original sources
PubMed1993

Optimal regional anaesthesia for abdominal hysterectomy: combined subarachnoid and epidural block compared with other regional techniques.

Regional anaesthesia for abdominal hysterectomy is commonly combined with heavy sedation or light general anaesthesia in order to avoid the occurrence of visceral pain. Our clinical experience has indicated that this pain can be controlled using regional anaesthesia techniques alone. In an effort to find the optimal technique, we randomly assigned 200 ASA and I and II patients who requested regional anaesthesia for abdominal hysterectomy (with or without elective appendicectomy) to one of five groups: 1) subarachnoid bupivacaine; 2) subarachnoid bupivacaine plus intravenous midazolam and buprenorphine; 3) epidural bipivacaine; 4) epidural bupivacaine plus epidural morphine; 5) subarachnoid bupivacaine plus epidural morphine and bupivacaine. The last combination provided by far the best analgesia. Only two of 40 patients complained of slight discomfort, and this was easily controlled. Success rates correlated also with the height of the blockade. It was concluded that the combination of subarachnoid bupivacaine plus epidural morphine and bupivacaine represents an effective and reliable technique for abdominal hysterectomy with or without elective appendicectomy.

Analgesia, Epidural↗
PubMed1984

[Is 0.5% bupivacaine solution isobaric?].

Bupivacaine 0.5% 3 ml was administered by subarachnoid injection to 100 patients. They were divided to four equal groups, according to the body position immediately following the injection: horizontal supine and lateral, sitting and Trendelenburg position. 15 min after the injection was the median dermatome in the later group at T 8.64, and after 60 min at T 7.44 level. The corresponding values for sitting patients were T 5.48 respect. T 3.08. It was concluded that subarachnoidally applied bupivacaine 0.5% shows hypobaric characteristics. This is in agreement with already reported in vitro determinations.

Bupivacaine↗
PubMed1983

[Avoiding hypoxemia during anesthesia].

The incidence of unexpected hypoxaemia during general anaesthesia was studied in 230 healthy patients undergoing a peripheral surgical procedure. Measurements of arterial oxygen and carbon dioxide tension (paO2 and paCO2) were performed under rigorously controlled conditions in regard to the age of the patients, their smoking habits, course and type of the anaesthetic and surgery, body position, inspiratory fraction of oxygen (FiO2), expiratory fraction of carbon dioxide (FECO2), respiratory minute volume and inspiratory to expiratory time ratio. 10% of the patients receiving FiO2 of 0.33 and 3.3% of those receiving 0.40 were found to have a paO2 below 80 mm Hg. 25% respect. 0% of older (greater than 60) and 6.7% respect. 4.4% of younger patients (less than 60 years) receiving FiO2 of 0.33 respect. 0.40 were hypoxemic (paO2 less than 80 mm Hg). These figures were compared with the results of an inquiry of practicing anaesthesiologists (in USA, West Germany and Switzerland) and their opinions about the safe FiO2 and paO2 limits. Most of the respondents use under the described conditions of this study an FiO2 of 0.33. At the same time 96% of them expect a paO2 over 80 mm Hg. On the basis of 10% incidence of hypoxaemic values among the patients studied it was concluded that FiO2 of 0.33 can not be considered as safe: increasing FiO2 to 0.40 helps to decrease the incidence of unexpected hypoxaemia especially in the patients over 40 years old.

Adolescent↗
PubMed1983

[Fatal lung embolism following ischemia and peridural anesthesia].

We report the case of a patient who died immediately following repair of a malleolar fracture. Post-mortem examination showed massive central and peripheral pulmonary artery thromboembolism. The possible causative role of peridural anaesthesia and/or ischaemic tourniquet technique are discussed. It is speculated that the combination of both techniques, but especially the last one, might be the provocative factor for such embolism in predisposed patients.

Anesthesia, Epidural↗
PubMed1983

[Phantom phenomena during regional anesthesia].

Phantom phenomena were studied following the administration of peridural (PDA), spinal (SA) and brachial plexus anaesthesia (PB) to 200 patients undergoing a peripheral surgical procedure. 18% of the subjects in PDA, 40% in SA and 63% in the PB group reported a typical, phantom of lower, respect. upper extremities as already described in the literature. Various additional (atypical) forms of phantoms were observed: 10% in PDA, 24% in SA and 6% in PB group. Sex, age, tourniquet, premedication and type of local anaesthetic did not influence substantially the occurrence of phantom. The latter was however directly related to the total dose (mg) of local anaesthetic administered. The appearance of phantom was not always a guarantee of successful block. The possible mechanisms of painless phantoms are discussed.

Adolescent↗
PubMed1982

[Peridural morphine in the treatment of postoperative pain (author's transl)].

The action of peridural morphine (1.5, 3.0 and 5.0 mg) as compared to placebo was studied in the patients who underwent inguinal hernia repair or lower extremity surgery under peridural anaesthesia. Morphine produced a dose-dependent intensive and long lasting segmental analgesia which was statistically significantly superior to placebo at all dosages. This action was however accompanied by a high incidence of urine retention and vomiting. We did not find any respiratory or circulatory depression. Nevertheless, it is accentuated that under different clinical conditions this depression might be highly probable.

Adult↗
PubMed1981

Phantom limb pain during peridural anaesthesia.

Report the occurrence of severe phantom leg pain during peridural anaesthesia. The patient had no preoperative pain complaints or neurological deficits and was scheduled for surgical removal of an osteosynthesis plate from his otherwise intact femur. The pain developed parallel with the appearance of phantom sensation during peridural anaesthesia. It was independent of surgical stimulation and vanished towards the end of the operation. Phantom limb pain disappeared completely with dissipation of regional blockade. Some of the possible mechanisms of painless and painful phantoms are discussed. We suggest that investigation of similar cases may help in elucidating phantom limb pain following irreversible pathological deafferentation.

Adult↗