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Biomedical subjects

U Aromaa

Publications and source records attributed to U Aromaa.

At least 19 recordsLinked to original sources
PubMed1991

Sensitivity, specificity and predictive value of the sensation of warmth as a method of detecting inadvertent subarachnoid injection of local anaesthetic when performing extradural blocks.

In order to test if the rate of onset of sensation of warmth in the legs after the injection of 0.5% bupivacaine might discriminate between subarachnoid and extradural injection, 150 urological patients were allocated randomly to receive either spinal anaesthesia with isobaric (IS) or hyperbaric (HS) 0.5% bupivacaine, or extradural anaesthesia with isobaric 0.5% bupivacaine. The volume of the local anaesthetic for spinal anaesthesia and for the extradural test dose was 3-4 ml. The patients were asked to report at once if they had a sensation of warmth in the legs during or after injection of local anaesthetic. The mean time to the sensation of warmth was significantly shorter in the spinal groups (80 (SEM 10) s in IS and 76 (8.0) s in HS) than in the extradural group (558 (38) s). However, six patients in the IS and two in the HS group had no sensation of warmth.

Adult↗
PubMed1988

Difficulties with tooth protectors in endotracheal intubation.

The suitability of three tooth protectors for routine use during endotracheal intubation was studied in 300 consecutive patients undergoing elective operations under general anaesthesia. The main disadvantages of the protectors were lack of space and the consequent difficulty of guiding the endotracheal tube into the larynx, and poor visibility, especially when the Camo protector was used. These difficulties could be avoided in most cases by cutting off the right angle of the Camo protector. The less experienced anaesthesiologists especially had difficulties with the protectors: 20% of patients in the Camo group were considered impossible to intubate unless the protector was removed. The silicone inlay of the Camo protector melts and becomes adhesive at body temperature, which makes its prolonged use hazardous. Two patients lost a maxillary incisor despite the proper use of a protector (Denex). Thus the use of a tooth protector alone does not guarantee avoidance of dental trauma. Better results could be obtained by improving the design of the protectors and by careful pre-anaesthetic dental examination.

Adult↗
PubMed1988

Double-blind comparison of transdermal scopolamine, droperidol and placebo against postoperative nausea and vomiting.

Since transdermal scopolamine (TS) seems effective against seasickness, we compared its antiemetic effect with intravenous droperidol (DHBP), our routine antidote for postoperative emesis. Ninety-six female patients (ASA I-II) scheduled for short-stay surgery were randomly allocated to three study groups after giving their informed consent. The three groups were as follows: TS adhesive, delivering 140 micrograms initially and 5 micrograms/h thereafter + placebo 0.5 ml i.v. 5 min before the end of surgery; transdermal placebo adhesive preoperatively + DHBP 0.5 ml (1.25 mg) i.v. 5 min before the end of surgery; transdermal placebo + 0.5 ml placebo i.v. as indicated above. Oxycodone i.m. and glycopyrrolate i.v. were given for premedication together with the test adhesive. Anaesthesia was induced with thiopental and maintained with nitrous oxide and oxygen, enflurane, vecuronium and fentanyl. Neostigmine and glycopyrrolate were administered for reversal. In the recovery room no differences in nausea or vomiting were observed between the groups. Sedation was significantly more marked (P less than 0.15-0.0001) after DHBP than after either TS or the given DHBP and 6% of those given the placebo (P less than 0.05). During the following 24 h nausea was reported more by the placebo patients (25) than by those on TS (20) or DHBP (15) (P less than 0.05). However, actual vomiting on the ward did not differ between the groups. Visual disturbances were more frequent after TS (P less than 0.01). We conclude that prophylactic transdermal scopolamine does not diminish postoperative emetic sequelae.

Administration, Cutaneous↗
PubMed1986

Ranitidine and prevention of pulmonary aspiration syndrome.

Thirty-seven patients undergoing elective abdominal surgery (excluding gastric operations) received either ranitidine 300 mg or placebo orally at 10 p.m. in the evening preceding surgery in a double-blind randomised study. The mean time interval between this oral premedication and induction of anaesthesia was 12 h. When compared to placebo, ranitidine decreased significantly (P less than 0.05) the amount of gastric juice, and none of the ranitidine-treated patients had an increased risk of acid pulmonary aspiration (pH below 2.5 and volume over 25 ml), while four patients in the control group had an increased risk (21%). The mean ranitidine blood level was 237 ng/ml at the time of induction of anaesthesia. It is concluded that in elective abdominal surgery ranitidine included in the premedication is likely to decrease the risk for acid pulmonary aspiration.

Clinical Trials as Topic↗
PubMed1986

Comparison of epidural and spinal blockade with 0.5% bupivacaine for transurethral surgery.

The suitability of spinal versus epidural blockade for transurethral resection of the prostate was studied in 60 patients randomly allocated to spinal and epidural anaesthesia groups. 0.5% bupivacaine (Marcain, Astra, Sweden) was injected at the L3-L4 interspace, the dose being 3 ml in the spinal group and 19 (16-25) ml in the epidural group. The blood pressure decreased similarly after both epidural and spinal injections, but the heart rate was not significantly altered. No statistically significant differences were found between the groups in any of the variables measured, including blood pressure, heart rate, intraoperative blood loss and per- and post-operative complications. However, altogether eight patients in the epidural group, but none in the spinal group, had to be treated because of hypotension (P less than 0.001). The main advantage of the spinal blockade was a faster and more reliable blockade of the lowest sacral segments, and the main advantage of the epidural blockade was a less pronounced and shorter duration of motor blockade.

Aged↗
PubMed1982

The role of halothane and fentanyl in the production of balanced anaesthesia.

The aim of the study was to quantitate the degree of respiratory depression when tolerance of superficial nociception and of an endotracheal tube was achieved by supplementing N2O + O2 anaesthesia either with halothane alone or with halothane in combination with fentanyl. Eighty-four patients, matched into seven groups, were studied after induction of anaesthesia with thiopental (4 mg/kg) and suxamethonium (3 mg/kg) using the following supplementation: 0.8, 0.6, 0.4% halothane alone or 0.4, 0.2, 0% halothane with 0.5-2 micrograms/kg fentanyl. After 10 min administration of the anaesthetic mixture using manual intermittent positive pressure ventilation (IPPV) (end-tidal CO2 c. 5.5%), IPPV was discontinued and spontaneous respiration allowed to return. When the end-tidal CO2 had stabilized, samples for blood gas analysis were taken and superficial antinociception was tested by pinching an inguinal skin fold. Supplementation of an N2O + O2 mixture with 0.8% halothane without fentanyl or with 0.4% halothane with 0.5 microgram/kg fentanyl seemed to come closest to the optimum in producing tolerance of an endotracheal tube and of superficial nociception (in about 85% of cases with an increase in PCO2 to only 7 kPa.

Adult↗
PubMed1980

The role of diazepam and fentanyl in the production of balanced anaesthesia.

The effects of diazepam-fentanyl combinations on consciousness, superficial nociception, respiration and circulation during N2O+O2 inhalation were studied in 40 premedicated patients during induction of anaesthesia. The balance between antinociception and anaesthesia was closest to the optimum in patients receiving 0.2 mg/kg of diazepam plus 1 micrograms/kg of fentanyl; the eyelid reflex was negative in all patients and only two out of ten patients reacted to abdominal pinching. When only 0.2 mg/kg of diazepam was given with N2O+O2, the eyelid reflex was negative in all patients, but half of them reacted to pinching. When the dose of diazepam was reduced to 0.1 mg/kg and patients received 1 or 2 micrograms/kg of fentanyl, the balance between anaesthesia and antinociception was good, but 30-50% of patients had a positive eyelid reflex and reacted to pinching. No distinct respiratory depression was observed in patients given 0.2 mg/kg of diazepam, whereas seven patients given 0.1mg/kg of diazepam plus 2 micrrograms/kg of fentanyl had apnoea lasting more than 60 s associated with a significant (P less than 0.05-0.001) increase in end-tidal CO2 and PCO2 in arterialised venous blood. No significant changes were observed in blood pressure or heart rate after any of the drug combinations studied. It appears that an optimal balance between anaesthesia and antinociception with minimal side-effects during balanced general anaesthesia requires reinforcement of N2O+O2 anaesthesia not only with fentanyl but also with hypnotics for sedatives.

Adult↗
PubMed1980

Venous complications after intravenous injection of diazepam, flunitrazepam, thiopentone and etomidate.

The occurrence of phlebitis, thrombosis, and thrombophlebitis after intravenous premedication with diazepam (0.15 mg/kg) dissolved in propylene glycol (Valium) or in polyethylene glycol (Diapam) or flunitrazepam (0.0125 mg/kg), and after intravenous induction of balanced general anaesthesia with thiopentone (4.0 mg/kg) or etomidate (0.3 mg/kg) was studied on the 7th and 14th postoperative days in 115 patients undergoing short-stay varicose vein surgery. Venous complications occurred most frequently after etomidate (43% at 14 days), thiopentone (23% at 14 days), and Valium (21% at 7 days). Diapam caused fewer venous sequelae (9% at 14 days) than Valium (18% at 14 days), but the smallest number of complications were noticed after flunitrazepam (8% at 7 days and none at 14 days). Venous sequelae were more severe and more extended after thiopentone and after etomidate than those after the diazepam preparations. It is concluded that venous complications after flunitrazepam premedication were mild and infrequent and that the incidence of such complications was unacceptably high after etomidate induction.

Adult↗
PubMed1979

Comparison of etomidate in combination with fentanyl or diazepam, with thiopentone as an induction agent for general anaesthesia.

In 104 premedicated patients undergoing general surgery, anaesthesia was induced either with etomidate 0.3 mg kg-1 preceded by fentanyl 1.25 or 2.5 microgram kg-1 i.v.or diazepam 0.0625 or 0.125 mg kg-1 i.v., or with thiopentone preceded by fentanyl 1.25 microgram kg-1 i.v. Despite the use of fentanyl or diazepam, the frequency of pain on injection in patients receiving etomidate was between 32% and 53%, being rated as severe in 5-20% of patients. No pain was experienced by patients receiving thiopentone. The frequency of involuntary movement was 15-35% with etomidate and 15% with thiopentone. The frequency of both pain and involuntary muscle movements was least when fentanyl 2.5 microgram kg-1 preceded the administration of etomidate. There was no significant relationship between the pain and muscle movement; three of 10 patients given etomidate into a central vein had such movements.

Adult↗
PubMed1979

Ornidazole and anaerobic bacteria: in vitro sensitivity and effects on wound infections after appendectomy.

The sensitivities of 68 clinical isolates of Bacteroides fragilis, 18 of Clostridium perfringens, and 11 of other Clostridium species were tested against ornidazole alone and in combination with ampicillin and gentamicin. A concentration of 3.1 microgram of ornidazole/ml inhibited 98% of the strains of B. fragilis, with greater sensitivity when ampicillin and gentamicin were also present. A concentration of 6.2 microgram of ornidazole/ml inhibited 16 of 18 strains of C. perfringens and all 11 strains of other Clostridium species. Concentrations in serum and tissue were determined after intravenous infusion of 500 mg of ornidazole 15 min prior to appendectomy. During the operation the concentration in serum was 7.90 +/- 0.57 microgram/ml, and in appendix tissue, 5.26 +/- 0.60 microgram/g. In the series of 200 patients undergoing appendectomy, six patients treated with ornidazole and 12 patients treated with placebo developed a wound infection. In patients with perforated appendix, the rate of wound infection was 7.1% in those given ornidazole and 63.6% in those given placebo (P = 0.004). Not a single B. fragilis was isolated from appendix swabs or wound exudates after prophylaxis with ornidazole.

Adult↗
PubMed1979

Premedication for out-patient endoscopy of the upper gastro-intestinal tract.

Upper gastrointestinal endoscopy was performed on 342 out-patients. The patients were allocated to four groups according to premedication given. The premedication used was atropine 0.1 mg/10 kg (A), atropine 0.1 mg/10 kg and diazepam 5 mg (AD), atropine 0.1 mg/10 kg and fentanyl 0.2 mg (AF), atropine 0.1 mg/10 kg diazepam 5 mg and fentanyl 0.2 mg (ADF). Premedication was given about 30 minutes before the procedure intramuscularly; the mouth and pharynx were sprayed with 10% lidoc,ine. The patients as well as the endoscopist considered the premedication in groups A and AD to be satisfactory. From the patient's point of view there were hardly any differences between the var;ous groups, except in drowsiness, which occurred more often in groups where fentanyl had been used. From the endoscopist's point of view groups A and AD were preferred because they offered better working conditions for the procedure. The longest period of observation was required in group ADF. On the basis of these results premedication with only atropine or if desired a combination of atropine and diazepam in addition to local sprayed anaesthesia of the mouth and pharynx is sufficient, and is recommended for endoscopy of the upper gastrointestinal tract.

Aged↗
PubMed1978

Streptokinase and concomitant oral anticoagulants in the treatment of deep venous thrombosis.

Fourty-four patients with deep venous thrombosis of the leg diagnosed by phlebography and not more than five days old were treated with streptokinase. Oral anticoagulant therapy was started at the same time. Complete lysis of thrombi was obtained in 6 cases and partial one in 25 cases. Lysis of proximal thrombi was better than that of distal ones. The age of the thrombi had no effect on the lysis. Urticaria and anaphylactic reactions occurred in 8 patients and treatment was discontinued. Haemorrhagic complications were present in 8 cases but remission was obtained by dicontinuing streptokinase infusion. Commencing oral anticoagulant therapy simultaneously with streptokinase reduces duration of treatment without increasing the risks and the results of lysis are equally good as with earlier studies. The use of streptokinase is recommended in the treatment of proximal deep venous thrombosis. This treatment offers a possibility of preventing a postthrombotic syndrome. The frequency of various complications should however be borne in mind.

Adult↗
PubMed1978

A comparison of naproxen, indomethacin and acetylsalicylic acid in pain after varicose vein surgery.

Oral naproxen in doses of 500 mg and 750 mg daily was compared with oral indomethacin, 75 mg daily, in a double-blind, completely randomized study of patients with post-operative pain after out-patients varicose vein surgery. Altogether, 120 patients were studied. In the study 750 mg naproxen proved to be equal in respect of analgesic efficacy to 75 mg indomethacin, and it was clearly superior to 1500 mg acetylsalicylic acid. Naproxen, 500 to 750 mg daily, afforded adequate post-operative analgesia in 98% of patients. The side-effects were mild. On the basis of the study, naproxen can be recommended as a pain-relieving drug after minor surgery, particularly when an antiphlogistic effect is also desirable.

Adolescent↗
PubMed1977

Anaesthesia for short-stay varicose vein surgery.

The study was undertaken in order to elucidate the suitability of four different types of general anaesthesia and of epidural block in short-stay varicose vein surgery. Special consideration was given to recovery after anaesthesia. The series consisted of 230 female patients subjected to varicose vein surgery of one lower extremity. The patients' recovery after surgery was observed through tests measuring visual-motor coordination and through questionnaires. The general anaesthesias used were halothane-nitrous oxide-oxygen anaesthesia with spontaneous respiration (Ha), relaxant-dominated combined anaesthesia (Re), analgesic-dominated combined anaesthesia (An), and analgesic-dominated combined anaesthesia with hyperventilation (Hy). Of the general anaesthesias, halothane nitrous-oxide inhalation anaesthesia gave the fastest recovery, although there were no major differences between it and analgesic-dominated combined anaesthesia. In contrast, immediate recovery was prolonged after hyperventilation and after relaxant-dominated anaesthesia. Epidural blockade provided a good alternative to general anaesthesia.

Adult↗
PubMed1977

The role of different components of balanced anaesthesia in tolerance to endotracheal intubation.

In order to demonstrate the role of anaesthesia, analgesia and muscle paralysis in suppressing the responses to nociceptive stimuli during balanced anaesthesia, the effect of tolerance to endotracheal intubation was used as a model during recovery from a suxamethonium block after different combinations of thiopental and fentanyl. The induction groups were: Thiopental, 4, 6 or 8 mg/kg, and thiopental, 4 mg/kg, supplemented with fentanyt, either 1 microgram/kg or 2 microgram/kg. All 107 patients received suxamethonium 1.5 mg/kg, after precurarization and recovery of muscle strength had been recorded by measuring the twitch tension of thumb adduction caused by indirect supramaximal stimulation of the ulnar nerve. With 4 mg/kg thiopental 60% of the patients reacted against the tube before the suxamethonium block had subsided. Increasing the dose to 8 mg/kg or supplementing the 4 mg/kg thiopental with 1 microgram/kg fentanyl reduced the reactions to about 30%. After supplementing with 2 microgram/kg fentanyl, 90% of the patients tolerated the tube. Reactions against the tube, if any, usually occurred before the twitch tension had recovered by more than 30%. After 4 and 6 mg/kg thiopental, about 10% of the patients started reacting before there were signs of recovery of twitch tension. The results show that if bucking or coughing are used as an indication of inadequate muscle paralysis overcurarization can easily occur. Tolerance to the endotracheal tube is more rationally achieved by small doses of narcotic analgesics (e.g. fentanyl, 0.5 to 1 microgram/kg) than by increasing the dosage of thiopental. This simple model has been found useful in demonstrating the basic principles of balanced anaesthesia at the beginning of training in the specialty.

Adult↗