R-wave changes in fatal air embolism during bone cementation.
Holter monitoring during cementation of a hip prosthesis showed sudden R-wave loss. At post mortem, demonstration of a large intracardiac air embolus may explain the ECG changes.
Aged↗
Biomedical subjects
S Felsby
Publications and source records attributed to S Felsby.
Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia.
Quantitative assessment of myocardial ischaemia during incremental spinal, single-dose spinal and general anaesthesia may provide guidelines for the choice of anaesthetic technique for osteosynthesis of hip fractures in the elderly atherosclerotic individual. Forty-three patients with coronary artery disease were allocated to receive either incremental spinal anaesthesia (bupivacaine 0.5% plain) (A), single-dose spinal anaesthesia (2.5 mL of bupivacaine 0.5% plain) (B) or general anaesthesia (fentanyl, thiopentone, atracurium, enflurane, N2O/O2) (C) for hip surgery. ST segment monitoring was performed from the induction of anaesthesia and for the following 48 h, and perioperative hypotension, blood loss and fluid therapy were recorded. ST depression developed in two out of 14 (A), seven out of 15 (B) and six out of 14 (C) patients (P = 0.14). In (A), a total of seven ST depressions occurred in the observation period as opposed to 125 in (B) and 16 in (C) (P < 0.05). Intra-operative ST depression only occurred in (B). Three (A), 33 (B) and 40 (C) hypotensive events were recorded (P < 0.002). Altogether, 56% of hypotensive patients developed ST depression compared with 10% of normotensive patients (P < 0.003). In (A), 1.6 mL of 0.5% bupivacaine were used as opposed to the fixed 2.5 mL dose in (B) (P < 0.001). In the first post-operative week, mortality was higher in (B) (P < 0.05) but, after 1 month, there was no significant difference in mortality between the three groups. The incidence of hypotension and myocardial ischaemia was lowest in the group receiving incremental spinal anaesthesia.
Aged↗
NMDA receptor blockade in chronic neuropathic pain: a comparison of ketamine and magnesium chloride.
Ten patients (4 female, 6 male) aged 34-67 years suffering from peripheral neuropathic pain participated in a double-blind placebo-controlled study where ketamine or magnesium chloride were administered by a 10 min bolus infusion (ketamine: 0.84 mumol/kg = 0.2 mg/kg, magnesium: 0.16 mmol/kg) followed by a continuous infusion (ketamine: 1.3 mumol/kg/h = 0.3 mg/kg/h, magnesium: 0.16 mmol/kg/h). Ongoing pain determined by VAS score, area of touch-evoked allodynia, detection and pain thresholds to mechanical and thermal stimuli were measured before and during drug infusion. Ketamine produced a significant reduction of spontaneous pain (57%) and of the area of allodynia (33%). Magnesium chloride reduced pain (29%) and area of allodynia (18%) insignificantly. Following ketamine there was a significant correlation between the reduction in ongoing pain and reduction in area of touch-evoked allodynia. Detection and pain thresholds to mechanical and thermal stimuli were not significantly changed by the drugs. These findings suggest that both ongoing pain and touch-evoked pain (allodynia) in neuropathic pain are inter-related phenomena, which may be mediated by the same mechanism and involving a N-methyl-D-aspartate receptor.
Adult↗
Combined spinal and epidural anesthesia.
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Anesthesia, Epidural↗
[Treatment of cancer pain with continuous opioid via spinal catheters].
Continuous intrathecal morphine treatment of cancer pain is reviewed on the basis of a literature search. Clinical, pharmacological and technical aspects are described, and the indications and potential complications are discussed. Three case histories illustrate the practical conduct and problems. The authors conclude that continuous intrathecal morphine treatment offers significant therapeutical advantages, when pain relief is not provided by conventional methods.
Analgesia, Patient-Controlled↗
[Analgesic effect of low-dose intra-articular morphine after ambulatory knee arthroscopy].
The purpose of this study was to demonstrate the effect of intra-articular morphine following knee arthroscopy performed in infiltration analgesia. Fifty-two healthy patients were randomized to receive either morphine 1 mg or placebo. The pain was assessed two, five, eight and 24 hours after the procedure by 1) a VAS scale and 2) the amount of acetaminophen consumed. Demographic data in the two groups were similar. The pain scores at eight and 24 hours and the acetaminophen consumption after eight hours were lower in the morphine group (p < 0.05). Our results confirm the hypothesis of peripherally distributed opioid receptors. Stratifying data in therapeutic vs. diagnostic arthroscopy suggests an additional effect of morphine in patients undergoing therapy (0.05 < p < 0.10), an aspect which supports the hypothesis of peripherally administered morphine acting as a potential suppressor of the substance P mediated cytokine cascade. Intraarticular morphine 1 mg after knee arthroscopy offers efficient analgesia lasting more than 24 hours. The method is devoid of side effects and deserves wider recognition.
Adolescent↗
[Analgesic effect of 2 different doses of intra-articular morphine after ambulatory knee arthroscopy. A randomized, prospective, double-blind study].
The effect of intra-articular morphine following knee arthroscopy has been verified in several studies, but the optimal dose has not been established. An earlier study by the authors showed significant effect of one mg morphine versus placebo. In this study, fifty patients were randomized to receive either two or four mg of intra-articular morphine following day-case knee arthroscopy in infiltration analgesia. The injected volume in both groups was five ml. The pain was assessed preoperatively, two, four, eight, 24, 36 and 48 hours after the procedure by 1) a VAS scale and 2) amount of acetaminophen consumed. Forty-seven patients completed the study. Demographic data in the two groups were similar. The results showed no significant difference in VAS score between the two dose regimes at any time. Onset of pain after cessation of the local analgesia was not influenced by the morphine dose. On this basis it is recommended to limit the dose of intraarticular morphine, as local adverse reactions to morphine cannot be ruled out.
Adolescent↗
[Combined spinal and epidural anesthesia. A review of the method].
UNLABELLED: Combined spinal epidural anaesthesia (CSE) offers the fast and profound neural blockade of spinal anaesthesia, but provides the possibilities of extension of the block and post-operative pain control. On the basis of a historical review, the advantages and drawbacks of CSE are discussed, and purpose-designed needles (Eldor 1 and 2, E-SP, T-A, Braun, Mediziv) are described. The dosage problems inherent in the technique and a possible solution to the "test dose" question are described. IN CONCLUSION: CSE is a valuable alternative to established regional anaesthetic techniques. The Mediziv needle offers several advantages, but a comparative study of the different needle types is needed.
Anesthesia, Epidural↗